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Gastroenterology (Expert Forum)
Recent dysphagia following incident...
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Recent dysphagia following incident...
by bmw1, Aug 17, 2003 12:00AM
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’s not getting worse, but it's not getting better. I seem to feel it more as the day progresses.
I don't know if the lettuce 'episode' caused injury - or whether something was already present there that caused the lettuce to get caught, and maybe this was the first thing to alert me to it.
My ENT did both direct (transnasal fiber optic) and indirect (mirror) laryngoscopies and found nothing. I wasn't sure whether he was able to see all the way down to the Crico muscle/UES, so the following week I visited a GI.
The GI said that if throat is scratched it can take 6 weeks to repair, and that might explain the symptoms.
What concerns me is that food on the right side is definitely not always 'going down' because I can sometimes 'pull' up food residue. It’s highly annoying.
Questions:
1) could abrasion cause the ongoing symptoms described?
2) GI mentioned Zenker's Diverticulum. Doesn’t that affect older people/quite rare? Don't 90% of ZDs occur on the left (this is on the right). Are there other pharyngeal 'pouch' conditions? (I have mild colon diverticulosis found during screening colonoscopy last yr)
3) What other conditions might be occurring at the juncture of the UES and the throat? I've read things about muscular spasms, asymptomatic GERD, etc, but wouldn't those be generalized and not specifically located on the right?
GI has me scheduled for Barium swallow this week. Says if that shows nothing to wait three weeks and if problem still present, would do endoscopy.
My old smoking history has me worried, though I know the age/incidence statistics show somewhat low carcinoma prevalence. But of course, every time I swallow, I am concerned.
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’s not getting worse, but it's not getting better. I seem to feel it more as the day progresses.
I don't know if the lettuce 'episode' caused injury - or whether something was already present there that caused the lettuce to get caught, and maybe this was the first thing to alert me to it.
My ENT did both direct (transnasal fiber optic) and indirect (mirror) laryngoscopies and found nothing. I wasn't sure whether he was able to see all the way down to the Crico muscle/UES, so the following week I visited a GI.
The GI said that if throat is scratched it can take 6 weeks to repair, and that might explain the symptoms.
What concerns me is that food on the right side is definitely not always 'going down' because I can sometimes 'pull' up food residue. It’s highly annoying.
Questions:
1) could abrasion cause the ongoing symptoms described?
2) GI mentioned Zenker's Diverticulum. Doesn’t that affect older people/quite rare? Don't 90% of ZDs occur on the left (this is on the right). Are there other pharyngeal 'pouch' conditions? (I have mild colon diverticulosis found during screening colonoscopy last yr)
3) What other conditions might be occurring at the juncture of the UES and the throat? I've read things about muscular spasms, asymptomatic GERD, etc, but wouldn't those be generalized and not specifically located on the right?
GI has me scheduled for Barium swallow this week. Says if that shows nothing to wait three weeks and if problem still present, would do endoscopy.
My old smoking history has me worried, though I know the age/incidence statistics show somewhat low carcinoma prevalence. But of course, every time I swallow, I am concerned.
Doctor's Answer
by Kevin Pho, MD, Aug 19, 2003 12:00AM
, Aug 19, 2003 12:00AM
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.
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.
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.
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...?