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Why Am I Getting Non-stop Heavy Symptom Of Feeling Something Prickly Stuck In My Throat?
Question: Dear Doctor,
I live in XXXX. I'm suffering form the non-stop heavy symptom of feeling something prickly stuck in my throat making me can't lead normal life at all. The location of the feeling keeps changing in the middle, right or left side of the throat. But it never disappear so long as I’m awake. I've no other symptom except this one.
I've seen many doctors of different specialties and ruled out many illness. Yesterday a new finding appeared. An ENT doctor did a videostroboscopy for me and found that there are bumps at my UES. He said that it is abnormal and may indicate that I have esophagitis that can be the reason of my non-stop heavy throat symptom. He asked me to seek opinion from GI. Kindly pls refer to the picture I uploaded.
Could you please advise me the possibilities of these bumps? Can it be the reason of my throat symptom?
Besides, I have mild Laryngopharyngeal Reflux (LPR) and I'm currently taking PPI everyday(double dosage for six months from Oct 2017 to Apr 2018 and then reduced to single dosage. ENT doctors saw some swelling in my throat while on-PPI 24hr PH study shows that I've little reflux. I used to stop PPI for 10 months that I think may be the reason to cause and worsen my throat symptom. Do you have any advice to treat LPR?
Thanks a lot.
XXXX
I live in XXXX. I'm suffering form the non-stop heavy symptom of feeling something prickly stuck in my throat making me can't lead normal life at all. The location of the feeling keeps changing in the middle, right or left side of the throat. But it never disappear so long as I’m awake. I've no other symptom except this one.
I've seen many doctors of different specialties and ruled out many illness. Yesterday a new finding appeared. An ENT doctor did a videostroboscopy for me and found that there are bumps at my UES. He said that it is abnormal and may indicate that I have esophagitis that can be the reason of my non-stop heavy throat symptom. He asked me to seek opinion from GI. Kindly pls refer to the picture I uploaded.
Could you please advise me the possibilities of these bumps? Can it be the reason of my throat symptom?
Besides, I have mild Laryngopharyngeal Reflux (LPR) and I'm currently taking PPI everyday(double dosage for six months from Oct 2017 to Apr 2018 and then reduced to single dosage. ENT doctors saw some swelling in my throat while on-PPI 24hr PH study shows that I've little reflux. I used to stop PPI for 10 months that I think may be the reason to cause and worsen my throat symptom. Do you have any advice to treat LPR?
Thanks a lot.
XXXX
Brief Answer:
Tell tale sign of acid peptic disorder in history.Endoscopy has to be done.
Detailed Answer:
Hello have gone through your query and seen attachment,
Most likely your symptoms are due to severe dyspepsia.You have Classical tell tale symptom of patient of acid peptic disorder. GERD/LPR is a condition in which stomach acid travels up the esophagus and to throat, which can then createscars that constrict the esophagus. Classical complaint of patient is that he/she can feel something is stuck in throat as you have mention.
Achalasia is a relatively uncommon condition that is often mistaken for acid reflux.It is a disease that effects the esophagus, specifically the junction between the esophagus and the stomach called the lower esophageal sphincter (LES). Achalasia is a condition where the valve (LES) fails to open.The photo attached by you could be suggestive of this also.
Tests suggested are-
Manometry-This test allows to determine if muscle disorders exist in the esophagus, thus making it difficult to push food and liquids down into the stomach.
Endoscopy should be done to see the inside of canal.A must for you.
See as the name suggests LPR should be treated in two phases-
1)Control production of acid-For which you are on Proton pump inhibitor.
2)To prevent the acid formed inside stomach to reflux back into esophagus-(This part of treatment is not covered by your doctor)-I would suggest you to add Levosulpiride. Itis a prokinetic drug and is very effective in controlling reflux of acid back into esophagus.A better way is to take it with Rabeprazole trials have shown that its very effective when combined with Rabeprazole.So you can switch over to Rabeprazole.
General precautions are-
Follow a bland diet (low acid levels, low in fat, not spicy)
Eat frequent, small meals.
Lose weight.
Avoid the use of alcohol, tobacco, and caffeine.
Do not eat food less than 2 hours before bedtime.
Raise the head of the bed before sleeping.
Avoid clearing of the throat.
Hope my answer was helpful.
Please do let me know if you need more details.
Tell tale sign of acid peptic disorder in history.Endoscopy has to be done.
Detailed Answer:
Hello have gone through your query and seen attachment,
Most likely your symptoms are due to severe dyspepsia.You have Classical tell tale symptom of patient of acid peptic disorder. GERD/LPR is a condition in which stomach acid travels up the esophagus and to throat, which can then createscars that constrict the esophagus. Classical complaint of patient is that he/she can feel something is stuck in throat as you have mention.
Achalasia is a relatively uncommon condition that is often mistaken for acid reflux.It is a disease that effects the esophagus, specifically the junction between the esophagus and the stomach called the lower esophageal sphincter (LES). Achalasia is a condition where the valve (LES) fails to open.The photo attached by you could be suggestive of this also.
Tests suggested are-
Manometry-This test allows to determine if muscle disorders exist in the esophagus, thus making it difficult to push food and liquids down into the stomach.
Endoscopy should be done to see the inside of canal.A must for you.
See as the name suggests LPR should be treated in two phases-
1)Control production of acid-For which you are on Proton pump inhibitor.
2)To prevent the acid formed inside stomach to reflux back into esophagus-(This part of treatment is not covered by your doctor)-I would suggest you to add Levosulpiride. Itis a prokinetic drug and is very effective in controlling reflux of acid back into esophagus.A better way is to take it with Rabeprazole trials have shown that its very effective when combined with Rabeprazole.So you can switch over to Rabeprazole.
General precautions are-
Follow a bland diet (low acid levels, low in fat, not spicy)
Eat frequent, small meals.
Lose weight.
Avoid the use of alcohol, tobacco, and caffeine.
Do not eat food less than 2 hours before bedtime.
Raise the head of the bed before sleeping.
Avoid clearing of the throat.
Hope my answer was helpful.
Please do let me know if you need more details.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. XXXXXXX
Thanks for you reply. I've been paying attention to all the general precautions you mentioned for a long time and my BMI is 20. I've no achalasia as per previous tests done. While, off-PPI 24hr PH study shows that I have mild reflux. But I have no other symptoms of reflux except the current throat symptom. I used to have dyspepsia after a stomach flu two years ago and it gradually developed into my current throat symptom, while my stomach is much stronger than then since I've been very cautions with my diet and lifestyle since then. I'm now still quite cautious on my diet & lifestyle to avoid reflux and I can feel that my stomach is much stronger than two years ago when I caught the stomach flu.
I've done upper GI endoscopy a couple of times in recent 3.5 years and the result shows nothings wrong. But they never do biopsy for my esophagus. Maybe I should repeat an upper GI endoscopy asking the doctor to pay special attention to those bumps on my UES and to see if there are also bumps along my esophagus.
Before doing the GI endoscopy I still want to ask you the question regarding the bumps on my UES as per the uploaded picture found by the ENT doctor:
1. Can these bumps be normal since the organ structure can be different for different individuals?
2. Can these bumps means that I have esophagitis? How to diagnose esophagitis?
3. Is there any other possibilities of these bumps? What are they?
4. Can these bumps be the reason of my current throat symptom?
5. What should the doctor do with these bumps when doing endoscopy for me? Can they remove them during the endoscopy?
Look forward to your reply & thanks a lot.
XXXX
Thanks for you reply. I've been paying attention to all the general precautions you mentioned for a long time and my BMI is 20. I've no achalasia as per previous tests done. While, off-PPI 24hr PH study shows that I have mild reflux. But I have no other symptoms of reflux except the current throat symptom. I used to have dyspepsia after a stomach flu two years ago and it gradually developed into my current throat symptom, while my stomach is much stronger than then since I've been very cautions with my diet and lifestyle since then. I'm now still quite cautious on my diet & lifestyle to avoid reflux and I can feel that my stomach is much stronger than two years ago when I caught the stomach flu.
I've done upper GI endoscopy a couple of times in recent 3.5 years and the result shows nothings wrong. But they never do biopsy for my esophagus. Maybe I should repeat an upper GI endoscopy asking the doctor to pay special attention to those bumps on my UES and to see if there are also bumps along my esophagus.
Before doing the GI endoscopy I still want to ask you the question regarding the bumps on my UES as per the uploaded picture found by the ENT doctor:
1. Can these bumps be normal since the organ structure can be different for different individuals?
2. Can these bumps means that I have esophagitis? How to diagnose esophagitis?
3. Is there any other possibilities of these bumps? What are they?
4. Can these bumps be the reason of my current throat symptom?
5. What should the doctor do with these bumps when doing endoscopy for me? Can they remove them during the endoscopy?
Look forward to your reply & thanks a lot.
XXXX
Brief Answer:
Follow up answer.
Detailed Answer:
Hi there,
"Maybe I should ............. esophagus"_Yes my dear patient a repeat endoscopy should be done and biopsies should be taken.Whether a growth any where in body is benign or malignant can be clarified pathologically only.No one has a expertise to insure you about nature of lesion by one photo.So biopsy is the only way out.
1)As already answered only pathological investigation could tell us the nature of lesion.
2)Esophagitis consists of two words-Esoph for esophagus and Itis which means inflammation( inflammation in body any where would always have this term itis with it.So see what happens is that many times due to reflux of acid or stomach contents into esophagus the mucosa and its layers get repeated injuries leading to inflammation.Endoscopy and biopsy can help us to find out esophagitis. Mild esophagitis is usually not seen by endoscope so in such case biopsy is taken and layers of esophagus are studied under microscope to see if there is inflammation or not.
3)As explained earlier what they are;can be explained by reports of biopsy. They can just be normal out growth or can even be any thing ranging from benign to malignant outgrowth of cells.
4)Possibly yes.
5)No initially they would take sample of small tissues from these bumps which they would send to pathology lab.These samples would be investigated by a pathologist to look for any pathological changes.Further treatment depends on the nature of lesion.
Hope i gave you a easy explaination,
Please feel free to clarify any doubts mam,
Suggestions for improving answer are welcome,
Regards and thanks.
Follow up answer.
Detailed Answer:
Hi there,
"Maybe I should ............. esophagus"_Yes my dear patient a repeat endoscopy should be done and biopsies should be taken.Whether a growth any where in body is benign or malignant can be clarified pathologically only.No one has a expertise to insure you about nature of lesion by one photo.So biopsy is the only way out.
1)As already answered only pathological investigation could tell us the nature of lesion.
2)Esophagitis consists of two words-Esoph for esophagus and Itis which means inflammation( inflammation in body any where would always have this term itis with it.So see what happens is that many times due to reflux of acid or stomach contents into esophagus the mucosa and its layers get repeated injuries leading to inflammation.Endoscopy and biopsy can help us to find out esophagitis. Mild esophagitis is usually not seen by endoscope so in such case biopsy is taken and layers of esophagus are studied under microscope to see if there is inflammation or not.
3)As explained earlier what they are;can be explained by reports of biopsy. They can just be normal out growth or can even be any thing ranging from benign to malignant outgrowth of cells.
4)Possibly yes.
5)No initially they would take sample of small tissues from these bumps which they would send to pathology lab.These samples would be investigated by a pathologist to look for any pathological changes.Further treatment depends on the nature of lesion.
Hope i gave you a easy explaination,
Please feel free to clarify any doubts mam,
Suggestions for improving answer are welcome,
Regards and thanks.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello Dr. XXXXXXX
Thanks a lot for your reply. It's very clear and you have covered all my inquiries. It's lucky that you're answering my questions.
FYI. I've done upper GI endoscopy three times in the past four years by different GI doctors. However, they never look carefully on my UES where I have symptom. In terms of biopsy, they only do it for the tissues of my stomach and the results are negative/normal. No biopsy has ever been done for the tissues of my esophagus.
I've also done many times of lanryngoscope by different ENT doctors since my symptom is in only in lower throat while this is the first time that bumps were found in UES and it's found by an ENT doctor in New York city.
As far as I know, it can be normal structure, eosinophilic esophagitis, other types of esophagitis, cysts, granulomas or tumor etc.
Anyway, I will find a reliable GI doctor to repeat an upper GI endoscopy for me and ask him/her to look carefully of my UES and esophagus and do biopsy for my esophagus. Hopefully, he or she can take some pictures of my UES and other parts of my esophagus.
Besides, I think I need to do a esophagram/barium swallow to determine if there is any other problem in my UES and esophagus. I've never done this test before.
And I will repeat manometry and do an on-PPI 24hr PH study to see if my reflux is well controlled by the PPI I'm currently taking, i.e. XXXXXXX lansoprazole 30mg/day. Last time I had these two tests was 1.5 years ago.
I have two more questions:
1) What is "Canal A" as you mentioned in your first time reply? You wrote that "Endoscopy should be done to see the inside of canal.A must for you."
2) I used to try different PPIs and there were no differences to me. Now I'm taking XXXXXXX lansoprazole 30mg/day before bedtime. What do you think is the best time to take XXXXXXX lansoprazole? FYI I need to take levothyroxine every morning 30mins before breakfast therefore I put PPI at bed time. Taking too many different medications give me burden and they may affect each other.
Hope you're OK with my long writing since I feel comfortable and helpful to communicate with you.
Best,
XXXX
Thanks a lot for your reply. It's very clear and you have covered all my inquiries. It's lucky that you're answering my questions.
FYI. I've done upper GI endoscopy three times in the past four years by different GI doctors. However, they never look carefully on my UES where I have symptom. In terms of biopsy, they only do it for the tissues of my stomach and the results are negative/normal. No biopsy has ever been done for the tissues of my esophagus.
I've also done many times of lanryngoscope by different ENT doctors since my symptom is in only in lower throat while this is the first time that bumps were found in UES and it's found by an ENT doctor in New York city.
As far as I know, it can be normal structure, eosinophilic esophagitis, other types of esophagitis, cysts, granulomas or tumor etc.
Anyway, I will find a reliable GI doctor to repeat an upper GI endoscopy for me and ask him/her to look carefully of my UES and esophagus and do biopsy for my esophagus. Hopefully, he or she can take some pictures of my UES and other parts of my esophagus.
Besides, I think I need to do a esophagram/barium swallow to determine if there is any other problem in my UES and esophagus. I've never done this test before.
And I will repeat manometry and do an on-PPI 24hr PH study to see if my reflux is well controlled by the PPI I'm currently taking, i.e. XXXXXXX lansoprazole 30mg/day. Last time I had these two tests was 1.5 years ago.
I have two more questions:
1) What is "Canal A" as you mentioned in your first time reply? You wrote that "Endoscopy should be done to see the inside of canal.A must for you."
2) I used to try different PPIs and there were no differences to me. Now I'm taking XXXXXXX lansoprazole 30mg/day before bedtime. What do you think is the best time to take XXXXXXX lansoprazole? FYI I need to take levothyroxine every morning 30mins before breakfast therefore I put PPI at bed time. Taking too many different medications give me burden and they may affect each other.
Hope you're OK with my long writing since I feel comfortable and helpful to communicate with you.
Best,
XXXX
Brief Answer:
Follow up suggestions.
Detailed Answer:
Hello again dear,
1)Canal means esophagus cavity(its a tubular structure).
And this test called endoscopy is A MUST FOR YOU.
2)Leviothyroxine should be taken empty stomach with just a sip of water preferably 60 to 90 minutes before having any thing.Clinically for best results 90 minute empty stomach time is required after taking the pill.Its a highly plasma bound drug and being empty stomach for minimum 60 minute is a must.30 minutes is too less a time for levothroxine. Just try this suggestion and you will see that effectivity of this plasma bound drug would increase by folds.
Best time for taking any ppi is 30 minutes before breakfast.
Take levothroxine with just a sip of water while you are on bed probably at 5-6 a.m(assuming that you take breakfast at around 8:30 in morning.
Remember one thing when its comes to thyroxine time of taking pill is much important then the potency you are on(Its a highly plasma bound drug and even a small amount of food can make it ineffective).Try it you would see results in 1 month.
Hope i was helpful.
Feel free to follow up i would be happy to provide you with any advice.
Warm regards.
Follow up suggestions.
Detailed Answer:
Hello again dear,
1)Canal means esophagus cavity(its a tubular structure).
And this test called endoscopy is A MUST FOR YOU.
2)Leviothyroxine should be taken empty stomach with just a sip of water preferably 60 to 90 minutes before having any thing.Clinically for best results 90 minute empty stomach time is required after taking the pill.Its a highly plasma bound drug and being empty stomach for minimum 60 minute is a must.30 minutes is too less a time for levothroxine. Just try this suggestion and you will see that effectivity of this plasma bound drug would increase by folds.
Best time for taking any ppi is 30 minutes before breakfast.
Take levothroxine with just a sip of water while you are on bed probably at 5-6 a.m(assuming that you take breakfast at around 8:30 in morning.
Remember one thing when its comes to thyroxine time of taking pill is much important then the potency you are on(Its a highly plasma bound drug and even a small amount of food can make it ineffective).Try it you would see results in 1 month.
Hope i was helpful.
Feel free to follow up i would be happy to provide you with any advice.
Warm regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Hello Dr. XXXXXXX
You give me very helpful advice again. I will adjust the time to take my medications accordingly.
More questions upon seeing your reply...
1. What type of endoscopy should I do and what specialty doctor should I seek help to do it - GI or ENT? Kindly pls see the information as followings related to this question:
Based on your reply and to my understanding, Esophagoscopy is a must for me to do to investigate those bumps in my UES found by an ENT doctor in New York city who asked me to go to see GI to investigate it. I found an introduction for this procedure on website made by an ENT doctor in XXXXXXX USA. There are many good informative articles and videos from him on website. Here is the link if you're interested to have a look: https://www.youtube.com/watch?v=NG4rZ4aN7Lg
GI doctors only do EGD(Esophagogastroduodenoscopy) either in Canada or USA and there is nothing wrong with my stomach and duodenum both visually and pathologically according to the previous EGD done for me a couple of times. Therefore, I don't think there is a need to repeat examining my stomach and duodenum now, and the focus should be put on esophagus and especially UES where I have symptom and where the bumps are found if doing endoscopy again.
However, ENT doctors in Canada only do Laryngoscope not Esophagoscopy. They won't reach as deep as UES and told me that they can't see UES with laryngoscope. However, I find that there is an ENT doctor in XXXXXXX who can do Esophagoscopy.
I'm kind of confused and pushed in between GI and ENT. Based on the above information, do you have any advice what specialists I should see to do the endoscopy to investigate the bumps on UES and check the whole esophagus?
2. Is it that there are three layers of UES and cricopharyngeus is the middle layer of UES? What are they if yes?
Look forward to your reply.
My greatest thanks,
XXXX
You give me very helpful advice again. I will adjust the time to take my medications accordingly.
More questions upon seeing your reply...
1. What type of endoscopy should I do and what specialty doctor should I seek help to do it - GI or ENT? Kindly pls see the information as followings related to this question:
Based on your reply and to my understanding, Esophagoscopy is a must for me to do to investigate those bumps in my UES found by an ENT doctor in New York city who asked me to go to see GI to investigate it. I found an introduction for this procedure on website made by an ENT doctor in XXXXXXX USA. There are many good informative articles and videos from him on website. Here is the link if you're interested to have a look: https://www.youtube.com/watch?v=NG4rZ4aN7Lg
GI doctors only do EGD(Esophagogastroduodenoscopy) either in Canada or USA and there is nothing wrong with my stomach and duodenum both visually and pathologically according to the previous EGD done for me a couple of times. Therefore, I don't think there is a need to repeat examining my stomach and duodenum now, and the focus should be put on esophagus and especially UES where I have symptom and where the bumps are found if doing endoscopy again.
However, ENT doctors in Canada only do Laryngoscope not Esophagoscopy. They won't reach as deep as UES and told me that they can't see UES with laryngoscope. However, I find that there is an ENT doctor in XXXXXXX who can do Esophagoscopy.
I'm kind of confused and pushed in between GI and ENT. Based on the above information, do you have any advice what specialists I should see to do the endoscopy to investigate the bumps on UES and check the whole esophagus?
2. Is it that there are three layers of UES and cricopharyngeus is the middle layer of UES? What are they if yes?
Look forward to your reply.
My greatest thanks,
XXXX
Brief Answer:
Follow up answer.
Detailed Answer:
Hello again and thanks for follow up my dear XXXXXXX
ENT means Ear Nose and Throat.So as the name suggest you have to be under a gastroenterologist. Area covered by ENT ends with throat As endoscopy was normal earlier the scope would be inserted till esophagus only and tissue from the bumps would be collected which would be send by your gastroenterologist to a laboratory to be inspected by a pathologist under a high power microscope.
Yes i have gone through the video link you have attached,Its ok trans nasal route can also be used.See the main thing is that we have to get samples of tissue from esophagus so whether we reach there through mouth or through nose doesn't really matters.However conventional approach is endoscopy done through mouth but yes if you want and can find doctor to go from trans nasal approach you can go for it also.
"I'm kind of confused and pushed in between GI and ENT- Based on the above information"-You can consult any one of them as mentioned by you in XXXXXXX you have found a doctor who can go for trans nasal approach then ok you can go for it,Otherwise go to any Gastro tell him your history and he would put endoscope till esophagus only.
2)After pathological investigation only we can comment on the layer from which they have originated.In easy language pathologist would use dyes on the tissue samples and would observe them under a microscopy to see which layer is involved.Naked eye examination or scopy can't rule out which layer is involved(these are microscopic details).
Hope i was helpful and answered your query in easy understanding language.
Feel free to follow up,
Any suggestions for making answer better are welcome.
Do rate the answer.
Wish you a good health and fast recover.
Regards!
Follow up answer.
Detailed Answer:
Hello again and thanks for follow up my dear XXXXXXX
ENT means Ear Nose and Throat.So as the name suggest you have to be under a gastroenterologist. Area covered by ENT ends with throat As endoscopy was normal earlier the scope would be inserted till esophagus only and tissue from the bumps would be collected which would be send by your gastroenterologist to a laboratory to be inspected by a pathologist under a high power microscope.
Yes i have gone through the video link you have attached,Its ok trans nasal route can also be used.See the main thing is that we have to get samples of tissue from esophagus so whether we reach there through mouth or through nose doesn't really matters.However conventional approach is endoscopy done through mouth but yes if you want and can find doctor to go from trans nasal approach you can go for it also.
"I'm kind of confused and pushed in between GI and ENT- Based on the above information"-You can consult any one of them as mentioned by you in XXXXXXX you have found a doctor who can go for trans nasal approach then ok you can go for it,Otherwise go to any Gastro tell him your history and he would put endoscope till esophagus only.
2)After pathological investigation only we can comment on the layer from which they have originated.In easy language pathologist would use dyes on the tissue samples and would observe them under a microscopy to see which layer is involved.Naked eye examination or scopy can't rule out which layer is involved(these are microscopic details).
Hope i was helpful and answered your query in easy understanding language.
Feel free to follow up,
Any suggestions for making answer better are welcome.
Do rate the answer.
Wish you a good health and fast recover.
Regards!
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Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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