lump in throat

[Luci]

I'm 53 and in good health except for hypothyroidism and about 30lbs overweight. I have had this feeling of something stuck in my throat for months.  I have had a few tests, such as a thyroid scan and swallowing study. Also, most recently a bronchoscopy. One of the tests showed a zenkers diverticulum but the GI dr says its too small to be causing any problems...the bronchoscopy showed Barretts esophogous and a biopsy was taken. GI Dr. thinks that reflux is causing the "global sensation" or lump in my throat but I have no feeling of acid reflud and avoid fatty foods. I have been on Nexium for two months and the lump is still there more than ever. It is not very noticeable when I wake up in the morning but its becomes more noticeable and annoying as the day goes on.  I have this every day now whereas before it used to come and go. It does not interfere with my swallowing but sometimes it feels so large that its strangling me.  I drink a lot of liquids trying to wash it down but nothing works.  I just finished a six week trip around the USA and tried different things to keep it away...such as no caffeine, or positional activities ie..not lying down to read etc. but sitting up straight.  I can't seem to connect it to eating, or taking pills etc.  It just starts coming as soon as I start my day. Any help you can give me will be greatly appreciated. Thank you. L. Rich.

[Kevin Pho, MD]

Erin has given a comprehensive answer and I agree with her post.  

In addition to GERD, abnormalities of the upper esophageal sphincter (UES), psychologic and psychiatric disorders, and stress can also be associated with a globus sensation.  

For this reason, I would agree with the recommendation of the ENT referral to evaluate the upper esophageal sphincter.  

In addition to pH monitoring, videofluoroscopic or manometric assessment of esophageal function can also be considered.  These are obviously specialized tests and should be considered if the ENT referral is non-revealing.

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.

[GI.PA]

This is a tricky one and a not-so uncommon referal to GI.

The "globus" senstation (" I feel like a jawbreaker is stuck inbetween my throat and food pipe...it seems to get worse at times and feel like it is strangling me") can be perplexing.

The most commonly noted cause is acid reflux disease.  Even though you have no "heartburn", small ammounts of acid can reflux into the throat at night (while you are asleep..dont feel it) and cause low grade sensitivity/damage that can plauge you during the day.  The key here is that is takes only a bit of acid to do this.  I routinely start patients on high doses of Nexium to see if it makes much difference, so you may want to talk to your GI about increasing you Nexium to 40mg twice a day (if it already isnt there).

You have had a swallowing study and upper endoscopy both showing no structural abnormality.  A 24 hour pH study while on Nexium can prove if there is silent reflux (silent meaning without symptoms).  If this test is normal (and you continue to get no response from double dose Nexium) reflux can be considered off the list of possible suspects.

An espophogeal motility study can look at the muscle contraction patterns in the upper esophagus to see if there are abnormal patterns suggestive of other diseases but this test for your symtoms is usually low yield for an answer.

An ENT (ear, nose and throat) referal may be in order to examine the back throat, early esophagus.

A trial of low dose antidepresants, like Elavil or Pamalor (too low to affect mood/depression, but just perfect to change muscle patterns/sensations) is an option.

Hope this helps.

Erin
GI.PA

[tessa0825]

Hi, may I ask what your biopsy report says about barretts?...Do you have metaplasia only or is there dysplasia present?..If you dont know, please call your Dr. and ask that question....Actually, I would ask for a copy of the pathology report so you can have it for your own file.....You need to be aware of whatever that answer is, its important that you understand the treatment options for different stages of barretts and that you make sure you get your continued surveillance EGDs and biopsies....Im confused when you say you went on a trip and you tried giving up certain foods for awhile such as caffeine...You should not be using caffeine or any of the other acid producing foods if you have barretts....Your Dr. needs to know that your medication isnt controlling your symptoms as there are other options available such as increasing your dosage, changing to a different PPI, or considering reflux surgery....Also, for those of us with reflux we have to do our share with this illness...If we arent willing to make the lifestyle changes, such as GERD diet, using a wedge for our bed to stop nite time reflux,not eating for several hrs before laying down, losing weight if needed, then we have to suffer the consequences.......If you are interested there is alot of info and some very good sites about Barretts on the web....One of them is the John Hopkins site, they even have an online support board for barretts pts...Two other good sites for info about it are Cleveland Clinic Site, and Mayo Clinic site.....Alot of info at this site.....www.barrettsinfo.com....Stay away from the unknown or unreliable sites for info about this. I read everything on every site I could find and made myself sick over it...I had "internet information overload", I interpretated half of it wrong because I dont have the scientific background to understand all of it. Now I only stick to the good reputable sites....Good luck, Tessa

[surgeon]

A zenker's can certainly cause the sensations you are having: it might be worth getting another opinion as to whether yours is really too small to be symtomatic.

[JB STEVENS]

Hi Luci:

My wife had the feeling of a lump in her throat and it got to where she could feel it.  It turned out she had a benign groth on her thyroid.  They removed one half of her thyroid.  That was about 10 years ago.  She now says she can feel the lump again and it sometimes seems to make it hard for her to swallow and she says it feels like it is cutting off he windpipe at times.  I feel sure your doctors have looked at this but if not, I would ask.  I am no Doctor so don't confuse what I say or get upset worrying about what I said, just ask your Doctor.

God Bless,
John B. Stevens