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Food Stuck Without Blockage in Esophagus vs Throat Lump

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Dr. Minocha  is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"

 

Some patients complain that food "sticks", or "hangs up" or "stops" in esophagus. In others, it feels like going very slowly down through the esophagus. Frequently no narrowing or stricture of esophagus is found. This is referred to as non-obstructive esophageal dysphagia

Distinction from Globus

Swallowing problems related to nonobstructive esophageal dysphagia are different from globus sensation (lump in throat) which is described at the end

Causes

1. Neuromuscular: Patients with nonobstructive esophageal dysphagia have some neuromuscular dysfunction involving the esophagus. Some of these have a well-defined motility disorder of esophagus, but no specific treatable abnormality is found in most of cases.

2. Acid Reflux or Heartburn: Nonobstructive esophageal dysphagia or swallowing difficulty are believed to be caused by gastroesophageal reflux or acid reflux disease. Acid reflux causes intermittent dysfunction of the contractions of esophagus.

3. Heightened visceral sensitivity: Some patients have a heightened sensation of food in esophagus, a sensation that is not seen in healthy individuals. This is analogous to the heightened sensations or perception seen in irritable bowel syndrome, noncardiac chest pain and many other chronic pain syndromes. Symptoms tend to get amplified if there are psychiatric issues like depression, anxiety or panic disorder. 

Dilation as treatment

Almost half of the gastroenterologists perform dilation of esophagus even though there is no overt stricture. It is felt that dilation helps many of these patients. Literature on this issue is controversial.

Univ. of MO: Marshall and colleagues (1996) found that among those who had dysphagia only to solids, dilation was effective in 95% cases compared to 12% in those who had difficulty swallowing both solids and liquids.

 

Phoenix, AZ: Colon et al. (2000) demonstrated that large diameter dilation indeed was helpful in 84% of the patients compared to 40% undergoing procedure with a narrow dilator.

Mayo Clinic: Scolapio et al. (2001) showed that dilation is not helpful compared to sham dilation. However, these investigators dilated only the lower end of the esophagus and not the entire esophagus.

Dr. Minocha: Preliminary results from our ongoing study (Digestive Disease Week, Atlanta, GA, 2001 presentation) show that both groups improved, but the magnitude of improvement using a large dilator (19 mm) for stretching the esophagus was similar to narrower dilator (13 mm). However, both groups received PPI drugs (Prilosec, Prevacid, Protonix, Aciphex or Nexium) and some experts present during the MidWest Gut Club meeting presentation in March 2001 argued that the improvement in all both our groups was occurring due to the fact the acid reflux is being blocked. This lends support to the concept that GERD or acid reflux disease plays an important role in the causation of such swallowing difficulties. 

Adjunctive Treatment

If dilation and PPIs fail to provide significant relief, many gastroenterologists use a trial of antidepressants, although there are no studies. 

GLOBUS SENSATION

Globus is different from dysphagia described above. Globus patients describe a feeling of constant lump or tightness, choking or strangling of throat which tends to clear up temporarily when eating solid food or large amount of liquids. 

Swallowing is not a problem and emotional stress worsens the globus sensation. Acid reflux disease has been implicated in some cases. Globus also tends to get amplified when associated with psychiatric conditions like depression, anxiety, or panic disorder. 

Is it in the head?

 

However, globus is not just psychogenic, although psychologic problems and stress tend to be more common in globus patients than those without globus. Therefore, most physicians avoid the use of previously used term, globus hystericus, and prefer the term globus sensation or globus pharyngeus. 

Esophagus and acid reflux

Abnormalities of upper esophageal sphincter (UES) of esophagus may be involved. These abnormalities of UES may be brought about by acid reflux. The concept of heightened visceral sensitivity may also be involved as seen in irritable bowel syndrome, non cardiac chest pain and chronic pain disorders. 

Diagnosis of globus

The diagnosis is largely clinical. However, the globus may occur in patients with other esophageal problems. Also the diagnosis should be made after excluding a lesion in throat, neck and esophagus.

Globus Blockage in Esophagus vs throat lump top >>

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