In medical practice, for the diagnosis of diseases, the method of collecting an anamnesis is used, which consists of the patient's complaints and the history of their occurrence. Some symptoms indicate serious organic diseases, while others are correctly interpreted as discomfort that is not associated with the appearance of significant pathologies. And such a complaint as a sensation of a coma in the esophagus belongs to this category. Depending on the conditions of manifestation and severity, as well as the presence of some concomitant he alth disorders, it can be considered as a criterion for a gastrointestinal, neurological, endocrinological, cardiological disease or neurosis.
Symptom Description
A lump in the throat, esophagus or stomach is a symptom that is characterized as discomfort in the chest, neck or upper abdomen, a feeling of constant or intermittent pressure in these areas of the body, which sometimesaccompanied by soreness in the larynx, difficulty in swallowing or pain, belching or nausea. If this complaint is caused by the presence of a somatic disease, then it varies depending on movement, physical activity or meals. If it is a sign of a mental condition, then it is either permanent or shows itself in moments of stress and anxiety.
The patient needs to clearly define several aspects. First, is this symptom permanent or does it occur under any conditions. Secondly, what determines the intensity of its manifestation and when it changes. Thirdly, is the feeling of a coma in the esophagus accompanied by other symptoms, complaints, disturbances in well-being, is there loss of appetite, vomiting, nausea, weight loss.
Approach to review
The symptom described above should be considered from many points of view, initially implying that it is precisely a criterion for a somatic disease, and not a mental state. Only by excluding formidable diseases of the cardiovascular, endocrine, digestive and nervous systems is the presence of neurosis confirmed. That is, when there are no objective data to link the sensation of a lump in the esophagus, pharynx or stomach with diseases, it is customary to consider the psychological mechanism of their manifestation.
Before making an unambiguous reliable conclusion about the absence of somatic pathologies, it is requireda thorough examination of the patient, regardless of age. A competent assessment of all symptoms, examination of regional lymph nodes, fluorography, clinical blood tests, FEGDS, ultrasound of the heart and thyroid gland are required. Each patient, referring to a specialist with a similar symptom, should be prepared for the need for such an examination.
GERD symptoms
One of the common causes of coma in the esophagus is gastroesophageal reflux disease. The mechanism of its appearance is the insufficiency of the cardiac sphincter, due to which incomplete differentiation of the stomach and esophagus is allowed. The result of this is the frequent reflux of the acidic contents of the stomach into the esophagus, the epithelium of which is not adapted to such influences. A focus of inflammation is formed in its lower third, a number of symptoms appear.
The first complaint of patients with mild GERD is a feeling of coma in the esophagus and belching, sometimes accompanied by heartburn after eating. It is quite easy for the patient to associate the appearance of such complaints with food intake. As a rule, they develop immediately or in the first 30 minutes after eating, are not accompanied by pain. Sometimes there is also a feeling of fullness in the epigastrium and behind the sternum, heartburn, which is the more pronounced, the more food was consumed and the more actively the patient moves and leans after eating.
The stereotypical symptom of patients with more severe GERD and its complications is frequent heartburn and belching. Vomiting is rare, not accompanied by nausea, and usually stops immediatelyafter separating a meager portion of food eaten the day before. Sour taste in the mouth during the day and bitterness on the tongue after sleep are more common.
Such patients are recommended to eat 7-8 times a day in small portions and maintain a vertical body position for at least 1 hour after meals, give up alcohol and smoking. Patients with GERD often suffer from unmotivated dyspepsia, which makes the consequences of alcohol intake more difficult to bear. Smoking provokes increased gastric secretion and increases the rate of peristalsis, due to which the symptoms of belching and heartburn are felt more often and more acutely.
Due to discomfort, a feeling of heaviness in the abdomen or esophagus, as well as the effect of acidic contents on the esophagus, especially in small quantities, periodic hiccups and belching of air, this condition can be combined and interpreted by the patient as a lump in the stomach, esophagus or pharynx. Unlike a similar symptom caused by neurosis or psychological stress, in this case swallowing is freely carried out, although appetite may be lost.
Gastric causes
One should also consider gastric causes of coma in the esophagus, which cause this symptom at least as often as esophageal ones. Pathologies such as gastric ulcer, pyloric stenosis, tumors or duodenogastric reflux disease are observed very often. Banal gastritis can cause frequent belching and discomfort in the esophagus.
Often the cause of this symptom is the presence of a tumor formation in the digestive system. Then, in addition to feeling a coma inthe patient's stomach or esophagus is concerned about weight loss, frequent nausea with vomiting after eating, hiccups, unmotivated discomfort in the chest after meals. A specific symptom of stomach cancer is the presence of aversion to meat food, which is observed due to the impossibility of its complete digestion and the more acute manifestation of the above symptoms.
To identify the immediate cause of a coma in the stomach, throat or esophagus, it is necessary to undergo an examination. It consists of general clinical tests, examination of the lymph nodes of the body, x-rays of the chest organs, FEGDS. After identifying a specific disease, you should begin to treat it.
Treatment before a specific diagnosis is also advisable, but it will be non-core in nature and will consist of PP inhibitors (Lansozol, Pantoprazole) or histamine receptor blockers (Ranitidine, Famotidine). Taking them allows you to weaken the effect of the acidic environment of the stomach on the affected tissue of an ulcer or tumor, reducing the risk of bleeding.
Dysphagia
Dysphagia is a violation or difficulty in swallowing food, associated either with a violation of the innervation of the muscles of the pharynx, or the presence of a tumor in the upper digestive tract. These groups of diseases can cause a sensation of a coma in the esophagus when trying to swallow food, as well as fullness and discomfort in the chest. Outside of the act of swallowing, symptoms may either be absent, or the patient will feel heaviness in the chest and in the larynx, sore throat. A rare symptom is increased salivation and frequentunmotivated nausea.
In cases of significant obstruction of the lumen of the esophagus by a tumor, the ability to swallow food may be completely lost. Then, as a result of swallowing, food comes into contact with the narrowing of the esophagus or pharynx, causing nausea and vomiting. Vomiting of unchanged food that occurs immediately at the time of swallowing is called esophageal. Its cause is the presence of a tumor in the esophagus or pharynx, mediastinum. Rarely, an aortic aneurysm causes these symptoms.
In the paralytic form of oropharyngeal dysphagia caused by a cerebral infarction or the consequences of traumatic brain injuries, there may be a constant feeling of a coma in the esophagus associated with incomplete passage of food into the stomach. The solid components of swallowed food are constantly retained in the pharynx or esophagus, causing mechanical irritation in the chest and neck, sometimes accompanied by nausea.
Dyspepsia
Dyspepsia is an episodic disturbance of normal digestion and motility of the gastrointestinal tract. It is manifested by nausea, sometimes vomiting and loose stools, often causing a sensation of a coma in the esophagus and belching. Dyspepsia is associated with a violation of the standard diet and is more common in patients who already have some kind of digestive system disease.
Dyspepsia with gastritis is observed when eating fatty foods or overeating, smoking, drinking alcohol. As a rule, feeling the appearance of the coma in the throat, esophagus or stomach described above, the patient does not yet know whatdisease or condition caused it. Therefore, when such complaints are detected, it makes sense to diagnose regardless of age to exclude tumor diseases and ulcers.
Detection of gastritis with FEGDS is the best outcome, which requires only proper nutrition, smoking cessation and alcohol. However, especially when GERD or duodenogastric reflux disease is detected, FEGDS should be performed annually for dispensary observation. This is necessary for taking biopsy specimens and examining them for the appearance of tumor cells.
Over the past 10 years, this practice has become widespread in the CIS, having already proven its effectiveness. In Japan, over the past 30 years, routine FEGDS for complaints of dyspepsia, nausea, or a sensation of a lump in the esophagus after eating has saved hundreds of thousands of lives due to early detection of tumor diseases before the stage of metastasis.
Thyroid
The thyroid gland is located on the anterior surface of the cartilage of the same name. With its pathologies associated with an increase in the size of the organ or the formation of nodes, the appearance of specific symptoms is noted, one of which is a lump in the esophagus. The treatment of thyroid pathologies is of course not based solely on this complaint, in addition, in order to cause such pronounced symptoms, the increase must be noticeable externally. However, since these pathologies are often overlooked by patients, they should be considered in detail.
The increase in the size of the thyroid gland can be totalor nodal character. In the first case, the entire gland increases in size, which is observed in endemic goiter or hypothyroidism. Nodular growth of the gland is observed more often, although it is less often symptomatic. The nodules are usually small in size, however, if they are located on the back surface of the organ, they can irritate the larynx. The patient feels discomfort and perspiration in the trachea and pharynx. Diagnosis is based on the exclusion of diseases of the digestive system, ultrasound of the thyroid gland and the study of its hormones in the blood.
Mediastinal diseases
The mediastinum is called the anatomical region of the chest, which contains the esophagus, ascending aorta, lymphatic vessels and nodes, lung roots, trachea, intrathoracic vessels, nerves and regional fatty tissue. This is a place of close location of the organs of the cardiovascular, nervous, digestive, respiratory and lymphatic systems. And any of their defeat is manifested by a feeling of squeezing and discomfort in the chest, a feeling of a coma in the esophagus, belching. The reason for this is the close location of neighboring organs, their contact and mutual influence on each other.
Among the most common diseases of the mediastinal organs, tumors of the main bronchi and lungs, as well as swollen lymph nodes, should be distinguished. Aortic aneurysm is very rare, although its contribution to the formation of the symptom is often very significant. In the event of the appearance of tumors or enlarged lymph nodes, mechanical compression of the esophagus is observed, which causes choking and discomfort when swallowing,difficulty passing food, nausea and sometimes vomiting.
Lymph nodes are affected by diseases of the blood system (leukemia, hematosarcoma, lymphogranulomatosis, lymphoma), metastasis of tumors of the lung or main bronchi, breast, esophagus or stomach, as well as tuberculosis and sarcoidosis. Each of these diseases requires diagnostics and high-quality treatment in accordance with specialized protocols.
Psychological cause of the symptom
When a symptom such as a lump in the esophagus appears, the causes, treatment and grounds for a thorough diagnosis of which are explained above, one cannot ignore any manifestations of diseases of the digestive, endocrine, lymphatic, cardiovascular and respiratory systems. And often modern research methods cannot identify a disease that can cause such a complaint. In this case, when formidable diseases are excluded, it makes sense to look for the cause of a coma in the patient's psyche.
Chronic social stress, impaired adaptation of the patient to the conditions of work and life, as well as the loss of loved ones, failures in relationships or business - all this can cause discomfort in the esophagus due to autonomic reactions. The so-called lump in the throat, rising in moments of strong disgust, resentment, irritation, when a person, feeling powerless, wants to burst into tears and give up, should be discussed with a psychologist. But this should be done either after the exclusion of formidable somatic diseases, or simultaneously with their diagnosis.
CV
The sensation of a lump in the esophagus, the causes of which are described above in the relevant headings, is an important alarming symptom that cannot be ignored. Properly carried out diagnostics will allow to exclude the appearance of formidable diseases or confirm their presence in the early curable stages. Delaying diagnosis and attempting to attribute this symptom to psychological problems, which is also observed in many cases, does not lead to positive consequences. On the contrary, a quick diagnosis with general clinical tests, examination of the lymph nodes, FEGDS, fluorography, ultrasound of the heart and thyroid gland will quickly identify the cause of the symptom and begin to eliminate it.
