[39F] With chronic throat pain and difficulty swallowing

Patient Description

A 39-year-old female has been experiencing chronic throat pain and difficulty swallowing for a few months. The pain is exacerbated by solid foods and soda, and she often has to eat smaller, softer foods or chew for a long time. The pain is worse at the beginning of a meal and gradually lessens. She has difficulty swallowing pills unless they are gel-coated. She had a broken tooth with a suspected abscess around the time her symptoms began, which seemed to resolve on its own after taking antibiotics. She experiences daily heartburn, which is usually controlled with omeprazole, but is triggered by sweet tea, Gatorade, spicy foods, tomato-based, and citrus foods. She also experiences frequent chest pains, which she attributes to her asthma, and frequent nausea without blood in vomit or stool. Her medical history includes GERD, asthma, and a recent diagnosis of adenomyosis. She takes omeprazole, an albuterol inhaler, cetirizine for allergies, ibuprofen during her period, probiotics, vitamins B and C, and iron supplements during her period. No known drug allergies.

Arora's Assessment

What might be happening

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

Gastroesophageal Reflux Disease (GERD): GERD is a chronic condition where stomach acid frequently flows back into the esophagus, causing irritation. This can lead to symptoms like heartburn, difficulty swallowing, and a sore throat. The fact that your symptoms worsen with certain foods and improve with omeprazole supports this diagnosis.
- Treatment: GERD is typically managed with lifestyle changes (avoiding trigger foods, eating smaller meals, not lying down after eating), medications like proton pump inhibitors (e.g., omeprazole), and sometimes surgical interventions in severe cases.
Esophagitis: This is inflammation of the esophagus, which can be caused by acid reflux, infections, or medications. Symptoms include painful swallowing, heartburn, and chest pain.
- Treatment: Treatment involves addressing the underlying cause, such as managing GERD, taking medications to reduce acid, and avoiding irritants.
Esophageal Stricture: This is a narrowing of the esophagus that can result from chronic acid reflux, leading to difficulty swallowing and food getting stuck.
- Treatment: Treatment may involve procedures to dilate (widen) the esophagus and medications to manage acid reflux.
Dental Abscess Complications: An untreated dental abscess can lead to infections that spread to nearby tissues, potentially causing symptoms in the throat.
- Treatment: Dental care to address the abscess and any remaining infection is crucial.

What you can do

While you should consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to manage your symptoms:

Continue Taking Omeprazole: Ensure you take your omeprazole as prescribed to manage your GERD symptoms.
Avoid Trigger Foods: Keep avoiding foods and drinks that trigger your heartburn, such as sweet tea, Gatorade, spicy foods, tomato-based foods, and citrus.
Eat Smaller, Softer Meals: Continue eating smaller, softer meals and chewing thoroughly to make swallowing easier.
Stay Upright After Eating: Avoid lying down immediately after eating to prevent acid reflux.
Hydrate Well: Drink plenty of water to help with swallowing and digestion.
Use MDandMe: Journal your symptoms, track your progress, and get insights. This can help you and your healthcare provider understand your condition better and adjust your treatment plan accordingly.

What you should look out for

Seek medical attention if you experience any of the following:

Severe Chest Pain: This could indicate a more serious condition and should be evaluated promptly.
Difficulty Breathing: If you have trouble breathing, seek immediate medical care.
Unintentional Weight Loss: Significant weight loss without trying could be a sign of a more serious underlying condition.
Blood in Vomit or Stool: This could indicate bleeding in the gastrointestinal tract and requires immediate medical attention.
Persistent or Worsening Symptoms: If your symptoms do not improve or worsen despite treatment, consult your healthcare provider.

Remember, while this advice can help manage your symptoms, it is important to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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6 mo ago

Top picked over-the-counter products for Acid Reflux (GERD): American College of Gastroenterology Guidelines