A constant unpleasant feeling of a lump in the throat, including when swallowing, associated with belching and lack of air, can be a manifestation of several different diseases. The sensation is often accompanied by discomfort when inhaling and a feeling of pressure.
Specialists from the First Family Clinic of St. Petersburg will help you find the true reasons for the sensation of a lump in your throat.
Painful swallowing
The content of the article
Painful swallowing (odynophagia) is a symptom that accompanies many diseases. It can be independent or coexist with dysphagia.
Pain when swallowing is felt at the level of the neck or in the chest area and is described by patients as painful squeezing, aching pain, a burning or tingling sensation. The pain may spread to the back.
Odynophagia often leads to weight loss. Her treatment is causal in nature.
Common causes of pain when swallowing:
- purulent sore throat;
- tongue abscess;
- peritonsillar abscess;
- epiglottis abscess;
- phlegmon of the floor of the mouth;
- throat cancer;
- laryngeal cancer;
- esophagitis (reflux, viral, fungal);
- foreign body in the throat or esophagus;
- damage to the wall of the throat or esophagus due to injury or a foreign body;
- Crohn's disease;
- scleroderma;
- Zenker's diverticulum;
- diphtheria of the pharynx;
- Plummer-Vinson syndrome;
- esophageal motility disorders.
Very hot or very cold drinks and foods can also cause a sore throat.
These are just some of the causes of a sore throat. In fact, there are several dozen diseases associated with this symptom.
Who to contact if you have a lump in your throat
The feeling of a lump in the throat is treated by a psychotherapist or psychiatrist. During the consultation, the doctor will assess the condition and determine the amount of assistance needed.
Help can be obtained in any clinic where there is a license to provide assistance in psychotherapy, psychiatry and neurology and where a psychiatrist or psychotherapist conducts an appointment.
ROSA Clinic
is a specialized and licensed clinic that provides assistance for all types of disorders accompanied by a feeling of a lump in the throat.
Our specialists
are ready to come to your home for consultation; you can also see a doctor in our clinic.
Treatment is most often carried out at home. If necessary, it is possible to be hospitalized in our own hospital, equipped with modern diagnostic equipment and where it is possible to carry out active treatment.
Non-cardiac chest pain
Chest pain can occur due to many reasons, since several important organs are located in this area - the heart, lungs, part of the spine, and the esophagus. This is a symptom:
- cardiovascular diseases;
- diseases of the respiratory system;
- diseases of the musculoskeletal system;
- diseases of the nervous system;
- gastrointestinal diseases.
In recent years, the term “non-cardiac chest pain” has come into use. It is defined as recurrent chest pain resembling angina pectoris, not associated with cardiovascular disease.
Non-cardiac chest pain may be a symptom of diseases related or not related to the gastrointestinal tract. A common cause of non-cardiac chest pain is GERD - gastroesophageal reflux disease. This disease most often occurs without changes visible during endoscopy (i.e. in the form of NERD - non-erosive gastroesophageal reflux disease).
Another reason is esophageal motility disorders..
The most common esophageal motility disorders in patients with this pain are nutcracker esophagus (spasm) and hypotension (related to hormonal factors) of the lower esophageal sphincter.
Causes of an unpleasant lump in the throat
- Overwork.
- Severe or long-term stress. Nervous tension.
- Neuroses and neurotic reactions.
- Depression.
- Anxiety disorder (phobias, panic attacks, generalized anxiety disorder, etc.)
- Psychosomatic diseases.
- Schizotypal disorder, schizophrenia.
- Consequences of organic damage to the nervous system after trauma. infections, strokes, heart attacks, etc.
- Diseases of internal organs (hyperthyroidism, thyroiditis, tonsillitis, spinal osteochondrosis, hiatal hernia, obesity or cachexia).
- Allergic reactions.
- Poisoning.
Functional chest pain syndrome of esophageal origin
Functional chest pain syndrome of esophageal origin
The syndrome is expressed by repeated chest pain of a visceral nature without an apparent cause. When diagnosing, it is necessary to exclude GERD; for this, endoscopy and measurement of pH in the esophagus with an assessment of impedance, and disorders of esophageal motility using esophageal manometry are performed.
Up to 80% of patients with this syndrome also have other functional disorders, for example, irritable bowel syndrome (27%), bloating (22%).
The pathomechanism of this syndrome is unknown. It is assumed that pain arises from hypersensitivity to physiological stimuli associated with psychosomatic disorders.
Many studies using balloon esophageal dilatation and electrical stimulation techniques show that patients with noncardiac chest pain independent of GERD have a decreased pain threshold. Hypersensitivity is associated with poorly understood dysregulation of the visceral nervous system, susceptible to external influences and aggravated by mental disorders, for example, anxiety attacks, depression.
There is little research on this matter. The incidence of non-cardiac chest pain is 19-25%, which is identical to the pain associated with GERD. The problem affects men and women equally and decreases with age.
Symptomatic therapy
If heartburn behind the sternum occurs no more than 2 times a week for less than 6 months, this is considered normal and does not require drug treatment. To reduce episodes of burning in the chest, it is recommended to review your diet: give up smoked foods, spicy and fatty foods, and reduce alcohol consumption as much as possible. To prevent gastric contents from flowing into the esophagus at night, it is better to sleep on a high pillow. It is useful to refrain from wearing compression belts, avoid bending the body and heavy physical work for an hour after eating.
The appearance of heartburn in the chest more than 2 times a week and the duration of one attack for more than 1 hour indicates the probable presence of an esophageal disorder or other gastrointestinal pathology. In such a situation, it is necessary to contact a gastroenterologist for examination and prescription of a drug therapy regimen. Until the clinical diagnosis is verified, antisecretory drugs, prokinetics, and antacids can be used to relieve discomfort. Psychotherapeutic treatments are effective for some patients.
Diagnosis of non-cardiac chest pain
The gastroenterologist excludes heart disease. Pain associated with GERD is indicated by a number of symptoms: the appearance of heartburn or acid regurgitation, pain relief after taking antacids.
In patients with concomitant dysphagia or odynophagia, immediate endoscopy is indicated to exclude a neoplasm. But if your doctor has ordered such tests, there is no need to panic—epidemiological studies show that gastrointestinal neoplasms are relatively rare in patients with noncardiac chest pain.
Other alarming symptoms indicating an organic cause of pain:
- age >50 years;
- weight loss;
- frequent vomiting;
- vomiting blood or “coffee grounds”;
- anemia;
- tumor palpable in the abdominal cavity;
- the presence of a tumor in the upper gastrointestinal tract in relatives.
Survey
Diagnosis is carried out by a gastroenterologist. When choosing methods, it is assumed that heartburn in the chest is more typical of damage to the upper digestive tract. The examination includes modern laboratory and instrumental studies to assess the functional and morphological state of the gastrointestinal tract. The most valuable in diagnostic terms are:
- Endoscopy
. Endoscopic visualization of the esophageal and gastric mucosa is an informative method for confirming gastroesophageal reflux, the most common cause of heartburn. During endoscopy, it is possible to establish signs of inflammation and detect areas of pathologically altered tissue. If necessary, a biopsy of mucosal areas is taken. - Radiography
. A series of x-rays after oral contrast with barium sulfate is used to detect cicatricial deformities, strictures, and large tumors in the esophagus and stomach. Using radiography, the speed of contrast movement through the gastrointestinal tract is monitored, which makes it possible to assess the contractile function of smooth muscles. - Ultrasound scanning
. Abdominal ultrasound is prescribed to all patients with a burning sensation in the chest as a quick and non-invasive screening method that helps identify nonspecific signs of inflammatory processes or morphological changes in organs. According to indications, targeted sonography of individual organs is performed - liver, pancreas. - pH-metry
. Measurement of total acidity and free hydrochloric acid is used to detect hypersecretion of gastric parietal cells leading to heartburn. Intraesophageal pH-metry has a high diagnostic value; normally, the acidity level should be above 4 units. Additionally, a blood test is taken to determine the level of pepsinogen and gastrin. - Stool analysis
. Diseases of the pancreas and biliary system, which are often accompanied by a burning sensation in the chest, are always manifested by changes in the coprogram. A standard macroscopic and microscopic examination of stool is recommended, and, if necessary, a reaction to occult blood. According to indications, the level of pancreatic elastase is determined.
It is mandatory to conduct manometry to study the contractility of the lower esophageal sphincter. The examination plan for the presence of substernal heartburn includes standard laboratory methods. An advanced biochemical blood test with liver tests is necessary to assess the activity of digestive processes and the functional state of the hepatobiliary system. After excluding organic causes of heartburn from the gastrointestinal tract, a neurological examination is necessary.
The doctor selects drug therapy for heartburn
Trial of proton pump inhibitor therapy
A test involving short-term therapy with high doses of a proton pump inhibitor for non-cardiac pain has both diagnostic and therapeutic value.
Patients are prescribed 60-80 mg/24 hours of omeprazole, esomeprazole or pantoprazole and 30-90/24 hours. lansoprazole. Duration of trial therapy is up to 28 days. The sensitivity of this test is estimated at 69–95% and specificity at 67–86%.
Patients who do not respond to treatment attempts with proton pump inhibitors should undergo the following procedures:
- daily impedance-pH-metry of the esophagus, which makes it possible to diagnose non-acid reflux, the symptoms of which persist after such treatment;
- esophageal manometry, diagnosing esophageal motility disorders;
- in cases of chest pain not associated with GERD or esophageal motility disorders, after excluding other causes, a consultation with a psychiatrist is prescribed.
Treatment depends on the type and severity of the condition causing chest pain.
How is the feeling of a lump in the throat treated?
Treatment is determined by the causes and mechanism of development of the disease and is selected individually for each patient.
For a recent and non-severe condition
treatment is carried out on an outpatient basis: the doctor conducts a psychotherapeutic session, prescribes medications that the patient takes at home and periodically comes for follow-up consultations.
For moderate severity
- treatment in a day hospital is recommended: daily treatment procedures are carried out (drug infusions, physiotherapy, etc.), which take an hour and a half, but the patient lives at home and goes about his usual business. The average course of a day hospital is about 10 days.
In severe condition
hospitalization in a hospital is recommended. Due to intensive treatment, the condition can be stabilized already in the first hours of stay. The average length of hospital stay is 10 days (from 5 to 30 days depending on the severity of the condition and the body’s recovery abilities).
Main methods of treatment:
- Psychotherapy.
- Drug treatment (pharmacotherapy).
- Physiotherapy.
- Massage and manual therapy.
- Diet therapy.
- Biofeedback therapy.
Symptoms of intercostal neurosis
Only a doctor can make a correct diagnosis after a complete examination of the body. However, characteristic symptoms that will help you recognize intercostal neurosis yourself are:
- voluntary twitching muscles;
- pain between the ribs, in the area of the shoulder blades and lower back;
- discomfort when coughing, sneezing and sudden movements. The pain may be sharp, dull or aching;
- numbness at the site of damage to nerve fibers;
- During palpation of the ribs, sternum and lumbar region, pain may intensify.
Neurosis of the ribs is similar in symptoms to diseases of the heart, stomach and lungs. But the main distinguishing symptom of this disease is constant aching pain, which can intensify with sudden movements, palpation, sneezing or coughing. No painkiller can relieve these painful sensations.
