This topic is about a 34-year-old man who has an ileostomy and has undergone several surgeries related to it. Since his most recent surgery in 2023, he has been experiencing difficulties with swallowing, especially with the first bite of food or when eating quickly or not sitting upright. He is seeking advice from others who might have faced similar issues.

Here are some possible causes and helpful suggestions:

1. Possible medical causes:
- Scar tissue or adhesions that may have formed after multiple surgeries.
- Esophageal stricture, which can be diagnosed by an ENT specialist and treated with esophageal dilation, a quick procedure that might need to be repeated.
- Neurological factors, such as a mild stroke or spastic throat muscles, which can occur in conditions like multiple sclerosis.
- Nerve sensitivity or tension due to surgical healing.

2. Professional evaluation suggested:
- Schedule an appointment with an ENT specialist for a swallow study or endoscopy to check for a stricture.
- Consult a physician to rule out any stroke-related swallowing issues.

3. Eating techniques and self-care:
- Take small bites and chew thoroughly, up to 30 times.
- Eat slowly and pause between bites to allow food to clear the esophagus.
- Sit upright throughout the meal.
- Sip fluids before the first bite and continue sipping while eating. Warm drinks like tea can help with denser foods such as bread, toast, or crackers.
- Combine dry foods with liquids and start meals with smooth soups to see if dryness is the trigger.
- If coughing or choking persists, inform your doctor promptly.

4. Additional throat-muscle tips (from ENT guidance):
- Perform vocal exercises like enunciating an exaggerated "EEEE" at a high pitch.
- Playing a wind instrument, such as a recorder, can help strengthen swallowing muscles.

5. Safety note:
- Recurrent choking can become an emergency. Some people have reported needing to call emergency services before opting for esophageal dilation.