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Family Medicine (Expert Forum)
Dryness in the throat
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Dryness in the throat
by AlexJames, Dec 03, 2001 12:00AM
Hello
I have a strange sensation in my throat. It feels like it's very dry or like something is stuck in there. It's been like that for around a week. I don't suffer any other symptoms, my voice is clear and I don't have any difficulties swallawing... Is is something I should be worried about?
My local surgery takes about two weeks to get an appointment, so I thought I'd ask here first.
Any input appreciated.
Alex.
I have a strange sensation in my throat. It feels like it's very dry or like something is stuck in there. It's been like that for around a week. I don't suffer any other symptoms, my voice is clear and I don't have any difficulties swallawing... Is is something I should be worried about?
My local surgery takes about two weeks to get an appointment, so I thought I'd ask here first.
Any input appreciated.
Alex.
Doctor's Answer
by Forum-M.D.-DT, Dec 04, 2001 12:00AM
Thank you for visiting the Family Practice Forum.
You describe a "strange sensation in your throat". This may be caused by several conditions. On is allergies or allergic rhinitis. People who have allergies tend to have alot of nasal secretions which drain down the throat and may cause throat inflammation or irritation and may give the sensation that something is "stuck" in the throat. If you have no allergy symptoms (i.e. Runny nose, watery eyes, sneezing, etc.), there may be other causes to consider, the most likely one is Acid Reflux or Gastroesophageal Reflux Disease.
This is a condition where acid from the stomach "comes up" and may cause irritation of the esophagus with symptoms commonly present in the throat.
Up to 15% of the population will experience symptoms of GERD every month. The main symptom being "heartburn." Fortunately, in addition to diet and lifestyle modifications, several newer medications are now availiable which significantly reduce the frequency and duration of these episodes. This problem is largely underdiagnosed and inadequately treated in many cases due to patient self-medication of these symptoms through the vast array of antacids availiable.
GERD is, like the name implies, acid reflux. The stomach produces a large amount of acid. Normally, this acid stays in the stomach and does not "reflux" up into the esophagus due to the presence of the "lower esophageal sphincter" (LES). The LES closes after food passes through the esophagus into the stomach thereby keeping the acid where it belongs. The tissue of the esophagus is not able to withstand the high acid content of the stomach. Certain factors, however reduce the ability of this LES to fully close, thereby allowing acid to reflux back up into the esophagus. It is through avoidance of these factors that GERD and the heartburn that goes along with it can be prevented.
Factors which contribute to GERD
1. Eating large meals
2. Obesity
3. Hiatal Hernia
4. Caffeine
5. Smoking
6. Alcohol
7. Chocolate
8. Fatty or spicy foods
9. Peppermint
In most cases, controlling these factors alone will prevent GERD or result in significant improvement of the symptoms of GERD. Although "heartburn" is what is commonly discussed, other symptoms such as difficulty swallowing (dysphagia) or a fullness in the throat or bloated feeling may be described.
Diagnosis of GERD
A visit to the doctor to discuss the possibility of GERD should include the following:
1. A detailed history focusing on potential "risk factors" for GERD.
2. A blood test of liver function - to rule out hepatitis or gallbladder disease
3. A blood test of pancreatic function - to rule out pancreatitis as a potential cause for the symptoms.
4. A blood test for Helicobacter Pylori (H. Pylori) - this bacteria, which is present in everyone's stomach, will predispose individuals to increased acid secretion in the stomach and possibly peptic ulcer disease if an excessive amount is present. Through a blood test the "quantity" of this bacteria can be assessed. If too much is present, it is treated through the use of a high dose of acid blocking agents and multiple antibiotics. The success rate is >90% if treated correctly.
5. Upper GI Series - barium is swallowed and xrays are taken of the esophagus and stomach. The Upper GI is a good test for visualizing not only refulx, but other esophageal abnormalities, hiatal hernia, or peptic ulcer disease.
You physician may consider the following tests as well.
1. 24 hour esophageal pH monitoring
2. Esophogastroduodenoscopy (EGD) - a small camera is passed into the esophagus and stomach thereby allowing direct visualization of any abnormalities. The EGD is commonly done by a gastroenterologist or surgeon.
3. Berstein Test - a solution of hydrochloric acid is dripped into the lower esophagus. A positive test is one in which the patient's symptoms are reproduced.
Treatment of GERD
The first step the patient (and physician) should take if GERD is suspected is to reduce the risk factors listed above. That means limiting caffeine, alcohol, fried and fatty food, losing weight and avoiding chocolate and peppermint.
Other effective treatments include
1. Elevation of the head of the bed 6 inches.
2. Use of an antacid (Mylanta/Maalox 30ml) after meals and at bedtime.
3. Use of H2 Blockers (Zantac/Tagamet) to reduce gastric acidity
4. Use of agents which increase the ability of the LES to fully close (Reglan)
5. Use a "newer" agents such as Prilosec, Prevacid and Aciphex which serve to greatly reduce the acid secretion of the stomach and improve the ability of the LES to fully close.
This condition is quite effectively treated in the hands of a good physician. If it goes untreated, however or is only partially treated by patients "self-medicating" with over the counter medications, complications such as esophageal stricture (narrowing of the esophagus), peptic ulcer disease, Barrett's esophagus (pre-cancerous change to the tissue of the lower esophagus), and possibly gastric or esophageal bleeding may occur.
I hope this is helpful and please do not hesitate to contact me if I can be of further assistance.
You describe a "strange sensation in your throat". This may be caused by several conditions. On is allergies or allergic rhinitis. People who have allergies tend to have alot of nasal secretions which drain down the throat and may cause throat inflammation or irritation and may give the sensation that something is "stuck" in the throat. If you have no allergy symptoms (i.e. Runny nose, watery eyes, sneezing, etc.), there may be other causes to consider, the most likely one is Acid Reflux or Gastroesophageal Reflux Disease.
This is a condition where acid from the stomach "comes up" and may cause irritation of the esophagus with symptoms commonly present in the throat.
Up to 15% of the population will experience symptoms of GERD every month. The main symptom being "heartburn." Fortunately, in addition to diet and lifestyle modifications, several newer medications are now availiable which significantly reduce the frequency and duration of these episodes. This problem is largely underdiagnosed and inadequately treated in many cases due to patient self-medication of these symptoms through the vast array of antacids availiable.
GERD is, like the name implies, acid reflux. The stomach produces a large amount of acid. Normally, this acid stays in the stomach and does not "reflux" up into the esophagus due to the presence of the "lower esophageal sphincter" (LES). The LES closes after food passes through the esophagus into the stomach thereby keeping the acid where it belongs. The tissue of the esophagus is not able to withstand the high acid content of the stomach. Certain factors, however reduce the ability of this LES to fully close, thereby allowing acid to reflux back up into the esophagus. It is through avoidance of these factors that GERD and the heartburn that goes along with it can be prevented.
Factors which contribute to GERD
1. Eating large meals
2. Obesity
3. Hiatal Hernia
4. Caffeine
5. Smoking
6. Alcohol
7. Chocolate
8. Fatty or spicy foods
9. Peppermint
In most cases, controlling these factors alone will prevent GERD or result in significant improvement of the symptoms of GERD. Although "heartburn" is what is commonly discussed, other symptoms such as difficulty swallowing (dysphagia) or a fullness in the throat or bloated feeling may be described.
Diagnosis of GERD
A visit to the doctor to discuss the possibility of GERD should include the following:
1. A detailed history focusing on potential "risk factors" for GERD.
2. A blood test of liver function - to rule out hepatitis or gallbladder disease
3. A blood test of pancreatic function - to rule out pancreatitis as a potential cause for the symptoms.
4. A blood test for Helicobacter Pylori (H. Pylori) - this bacteria, which is present in everyone's stomach, will predispose individuals to increased acid secretion in the stomach and possibly peptic ulcer disease if an excessive amount is present. Through a blood test the "quantity" of this bacteria can be assessed. If too much is present, it is treated through the use of a high dose of acid blocking agents and multiple antibiotics. The success rate is >90% if treated correctly.
5. Upper GI Series - barium is swallowed and xrays are taken of the esophagus and stomach. The Upper GI is a good test for visualizing not only refulx, but other esophageal abnormalities, hiatal hernia, or peptic ulcer disease.
You physician may consider the following tests as well.
1. 24 hour esophageal pH monitoring
2. Esophogastroduodenoscopy (EGD) - a small camera is passed into the esophagus and stomach thereby allowing direct visualization of any abnormalities. The EGD is commonly done by a gastroenterologist or surgeon.
3. Berstein Test - a solution of hydrochloric acid is dripped into the lower esophagus. A positive test is one in which the patient's symptoms are reproduced.
Treatment of GERD
The first step the patient (and physician) should take if GERD is suspected is to reduce the risk factors listed above. That means limiting caffeine, alcohol, fried and fatty food, losing weight and avoiding chocolate and peppermint.
Other effective treatments include
1. Elevation of the head of the bed 6 inches.
2. Use of an antacid (Mylanta/Maalox 30ml) after meals and at bedtime.
3. Use of H2 Blockers (Zantac/Tagamet) to reduce gastric acidity
4. Use of agents which increase the ability of the LES to fully close (Reglan)
5. Use a "newer" agents such as Prilosec, Prevacid and Aciphex which serve to greatly reduce the acid secretion of the stomach and improve the ability of the LES to fully close.
This condition is quite effectively treated in the hands of a good physician. If it goes untreated, however or is only partially treated by patients "self-medicating" with over the counter medications, complications such as esophageal stricture (narrowing of the esophagus), peptic ulcer disease, Barrett's esophagus (pre-cancerous change to the tissue of the lower esophagus), and possibly gastric or esophageal bleeding may occur.
I hope this is helpful and please do not hesitate to contact me if I can be of further assistance.
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How common is Acid Reflux in young people? I am 20 years old, and don't really have any allergies and am in genereally in good health. I don't smoke and only drink occasionally. I am not exactly sure what "heartburn" means (English is not my first language), but I don't seem to have any other unusual symptoms.
The way it started was I developed some pain on the right side of the throat slightly below the Adam's apple, when I swallawed something (pain occured more with liquid being swallawed). I went to my doctor to check it out, and, after looking at my throat for 5 seconds said I had some infection, and gave me a prescription for penicillin. This seemed to get better, and then that strange sensation of "dryness" appeared. The throat on the right side still hurts sometimes when I swallaw. Feels like I have something in there, but I don't feel any inflamation (inflammation)/lumps.
I will make another doctor appointment for next week to check it all out. I hope I don't die before then!
Any more light on this would be appreciated, and thanks again.
Acid Reflux can be present at ANY age (including newborns). If you are not getting the answers you need to resolve the problem, then the ENTIRE throat/esophagus needs to be examined (i.e. further "down" that what your doctor can see when you just "open up and say "AHH"). This is typically done either by an Ear, Nose and Throat doctor (ENT) or a Gastroenterologist.
My approach to your problem would likely be to treat it as acid reflux, and if the symptoms did not improve significantly after a week or two on a stomach-acid reducing medication such as Prilosec, would be to have an ENT doctor look further down your throat.
I hope this clears things up for you.
Dean M. Tomasello, M.D.
with the dryness and burning of the throat. I also have Acid
Refulx.
Cheri