[34M] With chronic dysphagia and frequent vomiting

Patient Description

A 34-year-old male presents with difficulty swallowing solids and frequent vomiting without nausea for about six months. The vomiting occurs daily, especially when eating or bending over, and happens 4-8 times a day depending on food intake. The vomiting is not forceful, and there is no blood in the vomit. The patient reports a sensation of a lump in the throat that sometimes comes out when pressed, often triggering vomiting. He also experiences chest pressure but no changes in voice, difficulty breathing, or persistent cough. There has been an unintentional weight loss of about 10-15 pounds and occasional abdominal pain. No diagnostic tests like endoscopy or barium swallow have been performed. The patient has a history of schizophrenia and bipolar disorder diagnosed in his teenage years and a history of substance use disorder. He smokes half a pack of cigarettes per day and has been smoking since age 16. His diet includes a variety of foods, with a preference for salty foods and a dislike for sweets. He has not traveled outside the country in the past year. Currently, he is not taking any prescription medications for mental health or other conditions but uses over-the-counter medications like Pepto-Bismol and Goody's powders. There are no known allergies to medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Esophageal Stricture or Obstruction: This condition involves a narrowing or blockage of the esophagus, which can cause difficulty swallowing (dysphagia) and frequent vomiting. The sensation of a lump in your throat that sometimes comes out could be related to this. Common causes include chronic acid reflux, which you mentioned was not improved by antacids, or other underlying conditions.

    • Treatment: Typically involves endoscopic procedures to dilate (widen) the esophagus or remove any obstructions. Medications may also be prescribed to manage symptoms.

  • Achalasia: A rare disorder where the esophagus has trouble moving food into the stomach. This can cause difficulty swallowing, regurgitation of food, and weight loss.

    • Treatment: May include medications, endoscopic procedures, or surgery to help relax the esophageal muscles and improve swallowing.

  • Gastroesophageal Reflux Disease (GERD): Although you mentioned no heartburn and that antacids did not help, GERD can sometimes present with atypical symptoms like vomiting and a sensation of a lump in the throat.

    • Treatment: Often involves lifestyle changes, medications to reduce stomach acid, and in some cases, surgery.

  • Esophageal Cancer: While less common, persistent symptoms like difficulty swallowing, unintentional weight loss, and vomiting can be signs of esophageal cancer.

    • Treatment: Depends on the stage and may include surgery, radiation therapy, and chemotherapy.

What you can do

  1. Consult a Doctor: It is crucial to seek medical attention to get a formal diagnosis and appropriate treatment. Overcoming your fear of doctors is important for your health, and you might consider bringing a trusted friend or family member for support.
  2. Keep a Symptom Journal: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your healthcare provider. This can help in identifying patterns and triggers.
  3. Dietary Adjustments: Try eating smaller, more frequent meals and avoid foods that seem to trigger your symptoms. Staying upright for at least an hour after eating may also help reduce vomiting.
  4. Stay Hydrated: Frequent vomiting can lead to dehydration. Make sure to drink plenty of fluids.
  5. Quit Smoking: Smoking can exacerbate many gastrointestinal issues. Consider seeking help to quit smoking.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Severe Chest Pain: Especially if it feels like pressure or is accompanied by difficulty breathing.
  • Blood in Vomit: This could be a sign of a more serious condition.
  • Severe Weight Loss: Continued unintentional weight loss needs to be evaluated by a healthcare professional.
  • Inability to Swallow Liquids: If you start having trouble swallowing liquids, this could indicate a worsening condition.

Remember, while I can provide information and suggestions, it is essential to consult with a healthcare professional for a formal diagnosis and treatment plan.

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5 mo ago

People Also Ask

What could cause difficulty swallowing and frequent vomiting without nausea?

Difficulty swallowing and frequent vomiting without nausea can be caused by conditions such as esophageal stricture or obstruction, achalasia, GERD, or even esophageal cancer. These conditions affect the esophagus and its ability to move food into the stomach properly.

How is an esophageal stricture or obstruction diagnosed and treated?

An esophageal stricture or obstruction is typically diagnosed using diagnostic tests like an endoscopy or a barium swallow. Treatment often involves endoscopic procedures to dilate the esophagus or remove obstructions, and medications may be prescribed to manage symptoms.

What lifestyle changes can help manage symptoms of GERD?

Lifestyle changes to manage GERD symptoms include eating smaller, more frequent meals, avoiding foods that trigger symptoms, staying upright for at least an hour after eating, and quitting smoking. These changes can help reduce the frequency and severity of symptoms.

Why is it important to seek medical attention for persistent symptoms like these?

Seeking medical attention for persistent symptoms is crucial because they could indicate serious underlying conditions such as esophageal cancer or severe esophageal disorders. Early diagnosis and treatment can prevent complications and improve outcomes.

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