Past Question

Dear Dr. Spector,

For the past couple weeks I've had a terrible cough. Just a couple days ago I've developed a lump in my esophagus. When ever I swallow I feel like I have something stuck in my throat. If I start coughing really bad I start choking and can't breath.

What could this be?

Carrie,

Cary, NC

Dear Carrie,

By far, the most common diagnosis that is rendered in this situation is a subset of reflux known as LPR, or laryngopharyngeal reflux. Most people with this condition note a combination of the symptoms you've described (persistent cough / lump in the throat that is most noticeable when swallowing / occasional choking) along with hoarseness of the voice that seems to change in severity during the day. Sometimes the voice is worse on waking, sometimes patients note that it gets worse as the day goes on. Also, many people note an irritating need to clear the throat repeatedly. Singers often notice they can no longer hit the high notes anymore.

The fact that these problems could be related to stomach acid coming up into the throat is often a surprise to the patient, as 4 out of 5 people with this type of reflux have no symptoms of the more commonly recognized form of reflux, known as gastroesophageal reflux, or GERD. In this setting, the chest or upper abdomen has discomfort that frequently arises after eating something fatty or spicy, as shown on countless commercials for reflux remedies over the years.

If findings of redness or swelling in specific areas of the throat are noted during a routine examination, the diagnosis of LPR will strongly be suspected, and the patient will usually be counselled on ways to reduce reflux by changing certain habits, such as cessation of eating right before bedtime. I will usually also recommend a trial of high dose prescription antacid medications to look for a positive response, which often occurs within two weeks. Other diagnoses or tests will be considered based on findings at the time of examination, or if anti-reflux measures are not helpful, but the majority of the time, LPR is the culprit. Treatment is usually sucessful, and I have personally had patients suffer these symptoms for decades before the proper diagnosis is finally made.

Thank you for your question!

Jared E. Spector, MD

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