Recent dysphagia following incident...

42, M, good health, 6', 173lbs, gave up smoking 7+ years ago (9 pk yrs) - chewed 2mg Nicorette occasionally since then (max 4/day), drink wine (3-4/wk). Diet is good. I have many plant allergies w/sinus congestion, throat clearing, etc. On Effexor for depression and GAD last year - gained 40 lbs, so stopped and lost the weight. Dr. put me on Clonazepam 1.5mg/day for GAD (it helps). Never had heartburn I could feel, nor taken antacids. I have 2 cousins with severe GERD - one needed surgery. Father died of colon cancer age 66; no other cancer incidence on either side of family.

3 wks ago I was eating a salad and got a piece of (hard) lettuce caught in my lower right throat. For 10 minutes I tried dry/food/water swallows and coughing, but would not dislodge. It felt like it was far down, maybe an inch or two below my Adam's apple. Finally, I sat down, leaned over and coughed it up. I did not 'gag' or 'choke' during this episode - it was just stuck there and I could feel it.

Since then, I have had painless dysphagia, with the feeling of something stuck in my lower right throat. When I eat, especially certain foods like toast, or an apple, food residue gets 'hung up' in that area. Liquids and (some) foods do not cause the sensation, but I am compensating by swallowing 'down the left side'. It

[Kevin Pho, MD]

1) It is definitely possible that an abrasion can cause the symptoms.  A barium swallow would be the most reasonable next test.

2) Zenker's diverticula are usually discovered in older adults, although they have been described in children. Most patients present after the age of 50 (often above age 70), having had symptoms ranging from weeks to years.  It can occur on either side.  As far as I know, most of the outpouching conditions are variations on Zenker's diverticula.  

3) What you are describing is oropharyngeal dysphagia - i.e. between the UES and the throat.  Neuromuscular discoordination can result from disorders which involve the central nervous system, such as stroke and motor neuron disease (amyotrophic lateral sclerosis), or the peripheral nervous system, such as Bell's palsy or myasthenia gravis.  

Obstructions within the oropharynx are most commonly due to malignancies. However, obstructing lesions can also be benign, such as cervical rings or webs. Cervical osteophytes can also narrow the lumen and impede transit of the bolus.

The barium swallow is a good initial test, followed by endoscopy.    

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.

Lembo.  Pathogenesis and clinical manifestations of oropharyngeal dysphagia.  UptoDate, 2003.

[surgeon]

a zenkers really is a posterior midline structure, which can protrude to either side. It sounds like the plan recommended by your GI doc is a good one, and ought to find anything that could be causing the problem.

[bmw1]

Thanks Kevin for your response.

You state obstructions in the oropharynx are most commonly due to malignancies. Where exactly is the oropharynx, and wouldn't it have been observed through the direct and indirect laryngoscopies performed by the ENT?

As an aside, I have noticed the 'sensation' has been somewhat less in the last couple of days as far as food getting trapped.

[bmw1]

Kevin, in doing some research would it be preferable to have a Video Fluoroscopic Swallowing Study (VFSS) (modified barium swallow) if the condition appears to be oropharyngeal dysphagia?

This, as opposed to a esophogram barium swallow. I guess it's the difference between what an ENT Dr. and a GI Dr. might want to perform...?

[gkl]

A related discussion, Why not a modified barium swallow? was started.