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Is the pain while swallowing due to hiatus hernia?

Q: I am 22 years old. I don't drink or smoke. An endoscopy done a year back showed hiatus hernia. After 2 months, I started getting pain in the esophagus while swallowing. I went for a laryngoscopy and a MRI of the neck, which came out normal. I also had a barium swallow video done, which was normal as well. I get the pain particularly while swallowing smaller pieces like cornflakes, chips etc. and not while eating main meals. The pain has been there for 10 months now. What can it be and what is the treatment? The pain is below the throat, at the back. Is it some kind of allergy?

A:You have hiatus hernia which can cause reflux when the stomach acid juice refluxes back into the gullet and can cause inflammation. Subsequently in untreated people, after a long time the gullet can go narrower at the inflamed area leading to difficulty in swallowing, and this can be seen in the barium x-rays, Your x-ray was reported normal. Your difficulty in swallowing occurs only with crisps and chips and not with main meals. I do not feel that there can be any organic cause. Frequently motility disorder of the oesophagus can cause this problem but it should happen with all types of food. Still it is worth trying anti-motility drug to see the effect. I suggest you consult a gastroenterologist, and even a second endoscopy may be needed to totally rule out any narrowing.

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