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Alarm bells

Things are made worse when symptoms which occur in many harmless conditions can also be features of cancer.

41-year-old Patient 1 posted a message on the forum saying that for the last few months she'd had something stuck at the base of her throat, like a lump, that came and went. She'd had no problems swallowing food or drink.

Her GP could find nothing of concern but referred her anyway for a routine ear, nose and throat (ENT) clinic check-up. Something in the doctor's letter must have rung alarm bells because the hospital sent her an urgent appointment. Needless to say this freaked her out as her GP had been very reassuring.

The forum moderator suggested globus sensation or globus pharyngeus (pharyngeus referring to the back of the throat). No one is sure what causes this condition but there seems to be some problem with the co-ordination of the muscles at the back of the throat when saliva is swallowed. It used to be called globus hystericus, a rather unkind Victorian term that suggests a psychological disorder. But التوتر can play a part, though probably more as an aggravating factor than a cause.

Sometimes, once investigations have ruled out serious causes, reassurance is enough and globus symptoms settle eventually. Some people have found physiotherapy to relax the muscles of the throat helpful. If stress is a factor, العلاج السلوكي المعرفي (CBT) or مضادات الاكتئاب (which also treat anxiety) may be useful.

The medical term for difficulty in swallowing is dysphagia. It's normally used when there is difficulty taking down drinks or food. In mild cases, it can just feel as if food is taking longer to pass down the food tube (oesophagus). There may be no problem with liquids. In extreme cases, there is a problem swallowing food and drink, and you may vomit them back up. There can be all variations of severity in between.

التحقيقات

It's important to have dysphagia investigated as soon as possible because - although there are many other more common and less harmful causes - cancer of the oesophagus needs to be ruled out. Even more rarely, you can get cancer of the back of the mouth or throat, or سرطان الغدة الدرقية causing pressure on the oesophagus from outside.

The common test for dysphagia is an endoscopy. A thin flexible tube with a tiny video camera and a light is passed into the mouth and down the oesophagus into the stomach. They can spray your throat to make it numb and pass the endoscope while you're awake, or you can be made drowsy with a sedative injection.

Any suspected nasties can be identified and if necessary a خزعة can be taken.

Sometimes a barium swallow is suggested where you swallow some barium liquid and X-rays are taken of your oesophagus.

I'm not a betting man, but I would have wagered on Patient 1's endoscopy being normal as she had had no problems swallowing food or drink. It was indeed fine, and the specialist felt her symptoms might be due to acid reflux at the bottom of the oesophagus.

Solutions

According to other posters on the forum, digestive problems certainly seem to be a common cause of swallowing difficulties. Patient 2 said they were getting sore throats followed by bouts of acid reflux and wondered if there was a link between the two. Patient 3 had a feeling of a lump in the back of the throat for two years and was eventually diagnosed with ارتجاع الحمض و irritable bowel syndrome.

Patient 4 reminded us that the throat is also the crossroads between the digestive and respiratory systems. In her case, the problem seemed to be postnasal drip and was helped by a steroid nasal spray و cetirizine antihistamine tablets.

Allergies certainly seemed to feature widely on this forum page. Patient 5 was prescribed antihistamine tablets from her doctor and Patient 6's husband benefited from anti-allergy injections.

Logically, stopping smoking should help because it irritates the back of the throat and aggravates postnasal drip.

I guess the take home message is that if you feel like something is stuck in your throat but you have no problems swallowing food or liquid, it's very unlikely you have a serious cause. Nevertheless, consult a healthcare professional to make absolutely sure. There can be many causes and many solutions. Our knowledge about this particular problem is expanding daily, as are the available treatment options.