Hi, Difficulty in swallowing can be due to mechanical obstructive causes in the food bolus pathway or it could be neurological. Mechanical causes can be tumors, esophageal strictures, schatzki s ring etc. Neurological causes can be cerebrovascular accident affecting the muscles of swallowing leading to pooling of secretions, Parkinson s disease, dementia like Alzheimer s. Since there is a history of vomiting coffee colored vomitus, I would like to get a detailed history on the past history of similar such episodes, any associated symptoms, history of seizures / loss of consciousness, history of maleana (tarry black stools) an whether he has difficulty in swallowing both solids and liquids. Take the patient to the emergency at the earliest where a detailed clinical examination can be done to distinguish between mechanical and neurological causes. Furthermore, a CT head can be considered with or without an MRI scan to rule out a cerebrovascular accident. And an esophago-gastro-duodenoscopy can be considered to rule out any obstruction. Another important aspect is to maintain his nutrition. The Emergency physician would run the necessary steps and decide on Ryle s tube feeding or other modes of nutritional supplementation. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Devi Venugopal Rita, Internal Medicine Specialist