Hello Doctor, I am having pain while swallowing food and even while drinking water for some time. I have already undergone tests like endoscopy (UGIE), HRM/manometry, CT thorax and gastric emptying study. Endoscopy and CT were normal, but manometry showed ineffective esophageal motility. I also have a history of reflux/GERD and hypothyroidism. Currently my main symptoms are: Pain while swallowing food Pain while drinking water Mild throat/chest discomfort and anxiety due to pain No vomiting, no breathing problem, and bowel movements are normal. Recently I also noticed a small painful lump/swelling below the ear/upper neck area. Current medicines: Thyroxine Itopride Antacid/alginate syrup BP medicine (Telmisartan) Please suggest what could be the possible cause and what further evaluation or treatment is needed.