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Suggest Treatment For Esophageal Bleeding

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Posted on Tue, 10 Nov 2015
Question: Dear Sir/Madam
Today I experienced throat bleeding(fresh bright red blood) after taking solid food( suji halwa), most probably from hypo-pharynx or upper esophagus sphincter and I have also naso-pharynx bleeding occasionally. This type of things happened 3-4 times in a month. Sometimes this happens after quick drinking of water. I underwent mirror laryngoscopic examination but nothing found.
I have no symptoms like sore throat,cough, swallowing difficulty or lymph node swelling etc.
1) Can these are the symptoms of hypo-pharynx cancer?
2) In mirror laryngoscopic examination, is hypo-pharynx and upper esophagus sphincter visible clearly?
3) Can blood from esophagus come to throat/mouth after eating without vomiting?
4) From which point of the esophagus food can be come to throat without vomiting/regurgitation.
After quick drinking of water this happens too.
Please read carefully and reply.
doctor
Answered by Dr. Hariom Sharma (7 hours later)
Brief Answer:
Most probably you may be suffering from the nasopharyngeal bleed

Detailed Answer:
Hi Sir,
I have gone through your query in detail; it suggests that most probably you may be suffering from the nasopharyngeal bleed but to rule out the exact location and cause you may go for flexible endoscopy.

I would like to highlight your specific questions
1. Symptoms are against hypo pharyngeal cancer. I wouldn't consider cancer in the absence of difficulty in swallowing, bleeding without vomiting, no lymph node swelling and finding during laryngoscopy. Further more your age doesn't favour cancer pathology.
2. Those structures are visible during laryngoscopic examination. But they are not completely seen and they don't appear clear. Therefore my suggestion to go for flexible endoscopy.
3. Blood from oesophagous may not come to mouth in sitting position without vomiting or regurgitation.
4. Not at all.

No need to worry but I personally suggest to go for endoscopic examination of nose, nasopharynx, oropharynx and hypo pharynx.

Thanks
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Hariom Sharma (1 hour later)
Thank You for your reply.
1) Bleeding happens after taking solid food and drinking water quickly why?
2) There is metalic sensation after taking food and quick drinking water, when I spit there is blood why?
3) During mirror laryngoscopic examination, Is pyriform sinus visible clearly?
4) Difficulty in swallowing means Is there pain during swallowing?
5) I have several times tried to clear the posterior naso-pharynx but many times only green color phlegm came. I have no stuffy nose. Can it be naso-pharynx carcinoma?
6) During mirror laryngoscopic examination, few red lines are seen behind the throat. Can these be the potential site for bleeding?
7) During throat clearing( without coughing) there is also occasional slight blood comes. When I tried to pull the mucous green color mucous came without blood. After 10 second blood sensation and when I spit there blood. why?
8) Can one suffers LACK OF SALIVA, cause this type of throat problem?

Please reply.I think You understand my concern.
doctor
Answered by Dr. Hariom Sharma (2 hours later)
Brief Answer:
Most welcome

Detailed Answer:
Hi Sir,
You are most welcome.

I am giving the answer of your questions
1. Bleeding happens after taking solid food and drinking water quickly may be due to associated LPR i.e. laryngopharyngeal reflux.
2. Metalic sensation after taking food may be due to the acid reflux (LPR).
3. During mirror laryngoscopic examination, pyriform sinus is visible clearly.
4. Dysphagia means difficulty in swallowing and odynophagia means painful swallowing means both are different terms.
5. Red lines are seen behind the throat may be due to either erosion of mucosa of parynx or post nasal drip.
6. Not a potential site of bleeding.
7. Most probably either due to the nasopharyngeal infection or rhinosinusitis.
8. Not.

Thanks

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Hariom Sharma (7 hours later)
Thank You very much Sir.
Today I again did mirror examination of hypo-pharynx, oro-pharynx and naso-pharynx from TWO different ENT specialists. Everything is fine. I have already taken appointment for flexible ENDOSCOPIC view of pharynx which to be done on TUESDAY.

1) If it is LPR, why it did not show any cut mark or red mark in mirror examination?
2) In mirror examination can early stage naso-pharynx carcinoma be missed?
Because during examination both said everything is fine.
3) Since I never have anterior nose bleeding, what is the possibility of naso-pharynx carcinoma?
4) Are tinnitus and auto-phony both same?
Because I experienced auto-phony 3 days back only once while playing badminton with heavy sweating.
5) It has been 5 months of occasional spitting of blood as you described it from naso-pharynx, within that months if there is tumor, how far it could have grown?
6)Can it be detected by mirror examination?

Sorry for asking these type of questions. But I think You can understand my problem. Please reply. Thank You.
doctor
Answered by Dr. Hariom Sharma (45 minutes later)
Brief Answer:
Again most welcome

Detailed Answer:
Hi Sir,
I have gone through your follow up queries.

Again I am giving the answer of your questions.

1. May be missed due to the reflection of light.
2. In mirror examination i.e. posterior rhinoscopy most of time early stage naso-pharyngial carcinoma cannot be missed.
3. No possibilty of nasopharyngeal carcinoma in your case.
4. Tinnitus and autophony both are different. Autophony literally means hearing one's voice in one's own ear. This condition is commonly caused by a persistently open eustachean tube.
5. No need to worry about the nasopharyngeal carcinoma.
7. Yes, definitely.

Thanks

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Hariom Sharma (5 hours later)
Thank You very much Sir.
My last round of questions please reply.
1) From the above facts, what conclusion you have drawn? Whether I have to undergo any test or any suggestion?

2) Occasionally when I coughed, white sputum comes but after 10 second when I spit little blood comes. I NEVER have blood mixed with sputum. I have GERD.
Is it typical sign of lung cancer?
3) In lung cancer, is hemoptysis persistent or comes and goes or increases with time? Characteristics of hemoptysis?
Thank You very much Sir.
doctor
Answered by Dr. Hariom Sharma (13 hours later)
Brief Answer:
Most welcome

Detailed Answer:
Hi Sir,
I have gone through your follow up query.

Reply of your questions
1. You need to go for only flexible endoscopy.
2. Not a typical sign of lung cancer.
3. Persistent and increase with the time.

Wish you speedy recovery.

Thanks
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Hariom Sharma

ENT Specialist

Practicing since :2006

Answered : 1113 Questions

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Suggest Treatment For Esophageal Bleeding

Brief Answer: Most probably you may be suffering from the nasopharyngeal bleed Detailed Answer: Hi Sir, I have gone through your query in detail; it suggests that most probably you may be suffering from the nasopharyngeal bleed but to rule out the exact location and cause you may go for flexible endoscopy. I would like to highlight your specific questions 1. Symptoms are against hypo pharyngeal cancer. I wouldn't consider cancer in the absence of difficulty in swallowing, bleeding without vomiting, no lymph node swelling and finding during laryngoscopy. Further more your age doesn't favour cancer pathology. 2. Those structures are visible during laryngoscopic examination. But they are not completely seen and they don't appear clear. Therefore my suggestion to go for flexible endoscopy. 3. Blood from oesophagous may not come to mouth in sitting position without vomiting or regurgitation. 4. Not at all. No need to worry but I personally suggest to go for endoscopic examination of nose, nasopharynx, oropharynx and hypo pharynx. Thanks