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DocSpot: Swallowing

Dear Dr Margaret
For about a year I’ve had a swallowing problem on and off. Everyone I talk to tend to say it's all in my mind, but I don’t think it is. Every time I eat something, I feel it’s still there when I swallow. I'm 22 years old. Should I be worried about this? Or is it really all in my mind?

You don’t say whether you have discussed this with your doctor. If not, you should do so. Your doctor will ask you various questions, such as:
  • how long you have had the problem
  • whether it is worse with solid foods or with liquids
  • whether you feel the food is actually sticking (and if so, where), or whether you just have a feeling of a ‘lump in the throat’
  • whether you tend to regurgitate food or acid.

This information will give your doctor useful clues about the cause of your problem. Your doctor will also examine your throat and neck. A test may be necessary. The most common test is a barium swallow, in which X-rays are taken while you swallow barium. Barium is a substance that shows up on X-rays, so it gives a picture of how well you are swallowing. It will show if the muscles of the throat are working properly, and if there is any blockage.

If everything is normal, it is possible that the problem you are experiencing is due to anxiety and stress, or perhaps to acid travelling upwards from the stomach. In fact, these are probably the commonest causes of the symptom you describe. When we are stressed, we become hyper-aware of various real, but normal, sensations in our bodies that we do not normally notice. Because these sensations are real, I don’t quite agree with the idea that it is ‘all in the mind’, which suggests they are imaginary.
You mention that the swallowing problem is on and off. In general, swallowing symptoms that come and go are less worrisome than a problem that is there all the time or getting worse. And serious causes tend to occur mainly in older people.

Last updated; Thursday, September 3rd 2020

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