Swallowing Disorders

Symptoms & When to Seek Help

Share with your medical team whether solids, soft foods or liquids are hardest to swallow. Other features can include chest discomfort, food “sticking”, regurgitation, cough and weight loss. If symptoms are persistent or if you struggle with liquids, please seek assessment.

Swallowing Disorders Diagnostic Testing

A/Prof Talbot uses targeted testing to identify the exact cause before recommending treatment.

Barium swallow (X-ray): The patient swallows a contrast liquid (and sometimes a small solid, e.g., bread/marshmallow) and the passage from mouth to stomach is observed. Quick, painless, widely available; helpful for unexplained swallowing issues and reflux, though less precise than manometry.
High-resolution manometry (HRM): The single most important test for suspected oesophageal disorders. After a local anaesthetic to the nose/throat, a fine catheter is passed via the nose into the oesophagus to measure sphincter function and the strength/coordination of swallows. It takes only minutes and yields detailed information to guide treatment.
Endoscopy (gastroscopy) & adjunct tests: Used to assess for inflammation, structural narrowing, hiatus hernia and other causes. (Note: In achalasia, gastroscopy may appear normal; physiology testing is essential.

What To Expect

Most tests are day-only.

Manometry takes minutes; barium swallow is quick and painless. If a procedure is recommended, options include endoscopic day procedures or minimally invasive surgery with small incisions and a short stay. You’ll receive clear guidance on preparation, recovery and follow-up.

Risks & Considerations

All procedures carry risk (e.g., bleeding, infection, perforation, transient chest discomfort after dilation or myotomy).

Accurate pre-procedure diagnosis minimises over- or under-treatment and helps choose the therapy with the best benefit-to-risk profile for you.

In a tertiary referral practice, we regularly see rare conditions. Achalasia occurs in about 1 per 100,000 per year, I treat more than 25–30 patients a year.

Achalasia

Achalasia is the most common major swallowing disorder..

Diagnosis is often delayed because patients adapt and because endoscopy can look normal. Typical symptoms include chest pain, regurgitation, dysphagia and weight loss.

A/Prof Talbot offers the full range of achalasia therapies, tailored to your anatomy and goals:

Surgical myotomy (Heller)
Per-oral endoscopic myotomy (POEM)
Pneumatic dilation
Botox^® therapy

With extensive experience in both endoscopic and surgical approaches, A/Prof Talbot selects the option with the best long-term balance of symptom relief and side-effects.

Other Swallowing & Motility Problems

Oesophageal spasm and hypercontractile disorders
Ineffective/weak oesophageal motility
Swallowing difficulty related to reflux or a hiatus hernia

Functional symptoms requiring targeted rehabilitation and medical therapy.

I’m one of the only doctors in NSW who treats achalasia both endoscopically and surgically. It’s good to have both options for patients to choose from."

Why Choose Upper GI Surgery?

Precision diagnostics - NSW’s longest-established high-resolution oesophageal physiology lab to correlate symptoms with real physiology.
Full spectrum care - endoscopic and surgical options in one team, avoiding one-size-fits-all treatment.
Advanced achalasia expertise - comprehensive offering of Heller myotomy, POEM, pneumatic dilation and Botox, with careful selection for durability and safety.
Tertiary-level support - streamlined coordination with anaesthesia, radiology and allied specialists for complex cases.

"Difficulty Swallowing" or Dysphagia

Dysphagia is a complex and often subtle symptom.