Dr Julius Parker: Difficulty swallowing and sweaty feet

Q I am experiencing difficulty swallowing bulky foods. It feels as if the food — usually potato and bread — is getting stuck as it passes through the oesophagus. The location of the blockage seems to change from day to day — sometimes it’s behind the breastbone; other times it’s where the food enters the stomach. Also, there are some days when I experience no difficulty swallowing. I am otherwise healthy. What do you think?

A Symptoms that come and go do not often signify a serious disease, although it depends how long you’ve had these difficulties. That you’ve remained otherwise fit is reassuring.

Your age is important, as difficulty swallowing isn’t unusual in the elderly. Your doctor would ask if you’ve experienced vomiting or regurgitation of undigested food, or unexplained weight loss, whether your symptoms only involve solid food or also liquids, and if you need to chew more, or cut up your food into smaller pieces to avoid such symptoms. If you’ve one or more of these symptoms, your doctor is likely to suggest further investigations.

There are two common tests. One is an endoscopy, when a flexible tube with a camera at the end is passed down your gullet into your stomach. This allows your doctor to look for abnormalities. The other is a barium swallow. An x-ray is taken as you swallow a liquid. This outlines the shape of your gullet and the way the muscles are working.

If you’ve noticed no concerning symptoms, your doctor may consider a trial of antacid treatment, as acid indigestion, or reflux, can cause inflammation in the gullet and difficulty swallowing. Anxiety can cause this symptom and you’d be aware if you’re experiencing any stress.

Even if you have none of the above symptoms, I recommend you see your doctor if your difficulty in swallowing becomes more severe or persistent.

QI’ve a two-year-old who suffers from sweaty feet. Last week, she developed tiny bubbles all over her feet, which seem to be painless. Could this be a heat rash?

A Many children have sweaty feet, and many parents do, too. Her rash could well be the result of heat. If your daughter’s been wearing new shoes, or shoes for longer than usual, her feet may have become hot and damp. This could chafe the skin, causing redness and superficial inflammation, which may cause the skin to blister. I would expect this to settle quickly if you bathe, and carefully dry, her feet daily.

Using cotton socks, baby talc, and leaving her shoes off indoors will also help. You should carefully dry the toe webspaces, as it’s easy in these circumstances to develop athlete’s foot, a fungal infection which occurs between the toes. You could also use a moisturiser on her skin.

There are alternative explanations. If her rash was mainly around the toes, this may have been ‘hand, foot and mouth’ disease. This is a viral infection that affects children and, as its name indicates, small, whitish blisters are seen on the sides of the fingers and inside the mouth, as well as the toes. Children are off colour but not seriously unwell, and the blisters resolve over a week or so. A variety of eczema, called pompholyx, can also cause small blisters on the hands and feet, but this is unusual in children as young as two and, typically, these blisters are extremely itchy.

If your daughter’s symptoms rapidly resolved and appeared nowhere else on her body, I think the most likely explanation is a heat rash. If they persist or have started to occur elsewhere, I would recommend you see your GP for a further assessment.