Please help....

I'm a 26 yr. old white female who has recently quit smoking with the help of Wellbutrin. I drink occassionally.  My primary dr. had diagonesd me with GERD and put me on Aciphex back at the end of August 2003.  I no longer have heartburn but I do continue to belch quite a lot after I eat which at that point after I belch it feels like there is food or something caught in my throat and its like I can taste or smell the food that I just ate. I have no problems swallowing drinks/food (sometimes saliva/mucus seems to thick to swallow) no weight loss (wouldn't hurt for me to lose a few pounds), no vomitting, no diarherra.  I do seem to have a lot of postnasal drip and sinus/nasal congestion problems so on Nov. 26 I went to my ENT because I kept on feeling like there was a lump in my throat and I started to have anxiety (which I have been trying to overcome for almost a year now) because I was thinking I had throat cancer or something.  Well the ENT looked somewhat down my throat with a little mirror and told me to make all these different sounds and he said that he didn't see anything other than some swelling on my voice box which he thought was from the acid reflux but he really didn't think anything physical was there.  He also felt my neck/throat and looked up my nose.  He told me he tought that it was anxiety (which I already knew), postnasal drip and acid reflux and he also told me it could take up to 24 wks. for the Aciphex to start working.  Is that true?  Anyway, he told me to take Zrytec D and Flonase for 2-3 wks. and if not better to come back and do barium swallow.  My question is:

1) Could this feeling be caused by Acid Reflux eventhough I only tend to belch a lot, sometimes there is regrutation but not every often to mention? Or Postnasal Drip because when I wake up in the mornings it seems that I have a lot of thick greenish/yellow/brownish mucus collected in my throat and then I have to cough to get it out and that really seems to be when I feel that lump feeling in my throat?  Could coughing to get all that mucus out irriate my throat or make it swell where as if it feels like there is a lump in my throat?  

2)  Could having really bad dry mouth (more like burning tongue or burning mouth) lead to GERD because I use to be on Paxil CR for anxiety and obsessive complusive disorder then was switched to Zoloft (when I came off Zoloft - thats when it seemed like all the GERD smyptoms started) and I quit taking that because I was so sick of having really bad dry mouth but now I'm on Wellbutrin and I'm having really bad dry mouth again.  So can having really bad dry mouth make that feeling appear or make it worse?

3) Could this be anything serious like cancer, since I don't have any of the alarm symptoms?

4)  If this feeling is from GERD, will this feeling on lump in throat ever go away?

Sorry if it seems to be all grumbled up together but I'm really tired of being so worried which I know can contribute to this problem.

[Kevin Pho, MD]

To answer your questions:

1) The answer to both these questions are yes.  Both acid reflux and post-nasal drip can cause your symptoms.  The best way to differentiate between the conditions would be a upper GI series or 24-hr pH study to evaluate for GERD or a sinus CT scan to evaluate for post-nasal drip.

2) A dry mouth does not lead to GERD.  It may be possible that side effects of your medications may be leading to the dry mouth.

3) I cannot say whether this is cancer or not.  The most comprehensive test to see if your symptoms are related to cancer would be an upper endoscopy.  

4) If the lump in your throat (known as globus sensation) is caused by GERD, it will likely go away if the GERD is appropriately treated.  I would suggest further tests to nail down this diagnosis.  A GI referral may help.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.