Are swallowing problems a sign of gullet cancer?

The ability to swallow is something we take for granted right up until the moment that we lose it. Difficulty swallowing, or dysphagia, is an unpleasant symptom of a number of different things, some more serious than others. We turned to Dr Michael Glynn, a top gastroenterologist who sees a lot of patients with dysphagia, to answer our questions about swallowing problems.

What is dysphagia?

The word “dysphagia” describes difficulty in swallowing. (Odynophagia is the word for pain or discomfort on swallowing). In this regard, “difficulty” means that the food seems to hold up as it goes down. It may be slight and intermittent, or progressively severe. Dysphagia that gets progressively worse over a few weeks or is accompanied by weight loss is always more worrying. If there is major hold-up of food or liquids, they may be regurgitated, which the patient can usually report as a different symptom from vomiting. If the blockage is high in the gullet, there may be coughing and choking when attempting to swallow. When dysphagia is due to neurological problems with the initiation of swallowing, liquids may regurgitate back up the nose.

What are the main causes of dysphagia and who is affected?

There are many causes of dysphagia, including the following:

• Oesophageal cancer – this is the most worrying cause. Cancer of the oesophagus (gullet) is unusual under the age of 40. If the dysphagia is persistent over a few weeks or gets progressively worse, an urgent upper GI endoscopy is needed to rule out the possibility of cancer.
• Acid reflux – issues related to acid reflux tend to be less serious, but can still cause intermittent dysphagia. Acid reflux is where stomach acid comes up into the lower oesophagus because the ring of muscle (sphincter) that separates the gullet from the stomach is not very efficient.
• Benign stricture – this usually occurs after a long period of reflux, although the reflux itself may have not caused much trouble. The symptoms tend to progress more slowly than those of cancer and weight loss is less marked. 
• Achalasia – failure of the sphincter at the lower end of the gullet to open when it should. This means that food cannot enter the stomach, causing a backup in the oesophagus, which, in turn, leads to difficulty swallowing. This is quite a rare cause of dysphagia, although it has often been present for a long time before diagnosis.
• Stress – a feeling of swallowing difficulty high in the throat (known as globus) often has no definable cause and can be a symptom of stress.

When should I see a doctor about it?

Because of the concern about cancer, all patients who experience dysphagia for more than a short period (e.g. 7-10 days) should be referred to a specialist.