Feature Article

Swallowing difficulties: dysphagia and other oesophageal problems

Kerry J Breen



Dysphagia is a symptom that needs prompt and thorough investigation. Difficulties arise when presentations are atypical, but limitations of the diagnostic tests and lack of awareness of medication-related oesophageal damage can also create problems.

Key Points

  • Dysphagia and pain on swallowing require prompt investigation.
  • Up to 20% of patients with peptic stricture may be unaware of acid reflux symptoms.
  • Both radiology and endoscopy may miss a minimal stricture or motility disorders. Oesophageal manometry is essential if a diagnosis is not made after good quality radiology and endoscopy.
  • Minimal strictures and webs may be overlooked if the swallowing of a solid bolus is not assessed in the radiology study.
  • Several frequently used medications can cause or aggravate oesophageal ulceration, especially if passage through the oesophagus is delayed.