Today’s question from one our visitors is interesting since symptoms can indicate so many things. RefluxMD recommends that no frequent symptom should ever be dismissed since it usually means your body is trying to tell you something. Some symptoms, such as trouble swallowing, can indicate some serious conditions, and it is critical that a qualified specialist perform the necessary tests to properly diagnose the underlying condition.
I am having trouble swallowing. When I swallow it feels as if there is a knot in my throat. Also, I feel pain like heartburn every time. What should I do?
Thank you for your questions and I am sorry for your discomfort and pain. Trouble swallowing is something we refer to as an “alarm symptom” and should not be ignored. It could any of many issues. In fact, WebMD indicates that there are 55 different conditions associated with swallowing difficulty, a “pain” in your throat, or the sensation of a knot when you swallow. However, I would like to discuss several of the more common problems and focus on those that may suggest GERD as well.
Globus – The sensation of something stuck in the throat
Your description of “a knot in the throat” can be a condition called globus, which can be accompanied by pain, but more often it is pain-free. An interesting article on globus in the UK website Patient titled Globus Sensation suggests that this is fairly common among adults, even as high at 46% of healthy adults. The symptom is a feeling of an intermittent lump in the throat, and diagnosis can be challenging to determine the true underlying cause. There is some disagreement in the literature on the underlying causes of globus; however, physicians tend to agree that GERD can be one of the most common causes. Likewise, stress or anxiety is cited as an underlying cause, but here again, the experts are not in agreement. The World Journal of Gastroenterology offered their list of potential causes of globus in a May 2012 article:
- Gastroesophageal reflux disease
- Abnormal upper esophageal sphincter function
- Esophageal motor disorders
- Pharyngeal inflammatory causes, including pharyngitis, tonsillitis, and chronic sinusitis
- Upper aerodigestive malignancy
- Hypertrophy of the base of the tongue
- Retroverted epiglottis
- Thyroid diseases
- Cervical heterotopic gastric mucosa
- Rare laryngopharyngeal tumors
- Psychological factors and stress
If you suspect that globus is the cause of your trouble swallowing, the authors of the aforementioned journal recommend an evaluation by an ENT specialist. However, if other symptoms suggest acid reflux disease, you might consider an evaluation by a GERD expert as well.
Difficulty Swallowing (Dysphagia)
It is important to differentiate between a “sensation” of something in the throat and swallowing difficulties. Difficulty swallowing can indicate more advanced GERD and can be a symptom of more serious conditions such as Barrett’s esophagus and esophageal cancer. Dr. Chandrasoma participated in our article titled Difficulty Swallowing? See your doctor that highlighted several conditions, other than GERD, that could cause these symptoms:
- Nutcracker esophagus
- Esophageal spasm
- Weak peristalsis
- Aperistalsis (inability of the esophagus to squeeze at all)
- Eosinophilic Esophagitis
- Esophageal diverticuli, or abnormal out pocketing of the esophageal wall or lining
- Scleroderma, a connective tissue disease that sometimes affects the esophagus
As indicated in the title of that article, anyone experiencing difficulty swallowing should have an evaluation by a GERD specialist as soon as possible.
Achalasia or GERD?
Since you mention heartburn symptoms, we also think it is important to understand achalasia and its potential to create these symptoms. We recommend a short video from the Cleveland Clinic that offers an excellent discussion of achalasia by Dr. Siva Raja. With this condition, the LES keeps food from passing into the stomach, which can then result in heartburn symptoms similar to those caused by GERD. If you think this is the cause of your symptoms, a GERD expert can perform diagnostic tests and if confirmed, there are several treatment options for you to consider. Dr. Raja has also posted up a short video discussing the treatment options for achalasia.
I am sorry that we can’t be more specific; however, our hope is to provide you with information on possible conditions causing your symptoms and encourage you to contact the appropriate specialist for a more accurate and specific diagnosis. However, if this a result of GERD, we encourage you to manage is progressive disease aggressively. Here is what we recommend as a plan to reduce GERD symptoms;. 1) work to reduce and maintain your body mass index (BMI) at 24 or less.; 2) adopt a GERD-friendly diet; 3) make important lifestyle changes; 4) utilize the least powerful antireflux medications and limit your use to those days when you require them to manage your symptoms; 6). try several natural home remedies, and; 6) consider antireflux surgery if those actions fail.
I hope this helps
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