gastrointestinal disorders
Lump in Throat
Evaluation of Lump in Throat
The main goal is to distinguish globus sensation from true Dysphagia , which suggests a structural or motor disorder of the pharynx or esophagus. History of present illnessshould elicit a clear description of the symptom, particularly as to whether there is any pain with swallowing or difficulty swallowing (including sensation of food sticking). Timing of symptoms is important, particularly whether it occurs with eating or drinking or is independent of those activities; association with emotional events should be queried specifically. Review of systemsseeks weight loss (as evidence of a swallowing disorder) and symptoms of muscle weakness. Past medical historyshould include known neurologic diagnoses, particularly those causing weakness. The neck and floor of the mouth are palpated for masses. The oropharynx is inspected (including by direct laryngoscopy). Swallowing (of water and a solid food such as crackers) should be observed. Neurologic examination with particular attention to motor function is important. The following findings are of particular concern: Neck or throat pain Weight loss Abrupt onset Pain, choking, or difficulty with swallowing Regurgitation of food Muscle weakness Palpable or visible mass Progressive worsening of symptoms Symptoms unrelated to swallowing, with no pain or difficulty with swallowing, or sensation of food sticking in the throat in a patient with a normal examination imply globus sensation. Any red flag findings or abnormal findings on examination suggest a mechanical or motor disorder of swallowing. Chronic symptoms that occur during unresolved or pathologic grief and that may be relieved by crying suggest globus sensation. Patients with findings typical of globus sensation need no testing. If the diagnosis is unclear or the clinician cannot adequately visualize the pharynx, testing as for dysphagia is done. Typical tests include clinical swallow evaluation, plain or video esophagography (video barium swallow), measurement of swallowing time, chest x-ray, and esophageal manometry. 