In medical practice, for the diagnosis of diseases, an anamnesis collection technique is used, which consists of the patient's complaints and the history of their appearance. Some symptoms indicate serious organic diseases, while others are correctly interpreted as discomfort that is not associated with the appearance of significant pathologies. And such a complaint as a sensation of a coma in the esophagus belongs to this category. Depending on the conditions of manifestation and severity, as well as the presence of certain concomitant disorders of well-being, it can be considered as a criterion of a gastrointestinal, neurological, endocrinological, cardiological disease or neurosis.
Symptom Description
A lump in the throat, esophagus or stomach is a symptom that is characterized as discomfort in the chest, neck or upper abdomen, a feeling of constant or periodic compression in these areas of the body, which is sometimes accompanied by tickling in the larynx, difficulty in swallowing or pain, belching or nausea. If this complaint is caused by the presence of a somatic disease, then it varies depending on movement, physical activity or meals. If it is a sign of a mental state, then it either is permanent, or makes itself felt in moments of stress and anxiety.
The patient needs to clearly identify several aspects. First, whether this symptom is permanent, or whether it occurs under any conditions. Secondly, what determines the intensity of its manifestation and when it changes. Thirdly, is there a coma sensation in the esophagus accompanied by other symptoms, complaints, health problems, is there a loss of appetite, vomiting, nausea, weight loss.
Review approach
The symptom described above should be considered from many points of view, initially implying that it is precisely a criterion of a somatic disease, and not a mental state. Only by eliminating the formidable diseases of the cardiovascular, endocrine, digestive and nervous systems is the presence of neurosis confirmed. That is, when there is no objective data to link the sensation of a coma in the esophagus, pharynx or stomach with diseases, it is customary to consider the psychological mechanism of their manifestation.
Before making an unambiguous reliable conclusion about the absence of somatic pathologies, a thorough examination of the patient is required, regardless of age. It requires a competent assessment of all symptoms, examination of regional lymph nodes, fluorography, clinical blood tests, FEGDS, ultrasound of the heart and thyroid gland. Each patient, referring to a specialist with a similar symptom, should be prepared for the need for such an examination.
GERD Symptoms
One of the common causes of coma in the esophagus is gastroesophageal reflux disease. The mechanism of its appearance is the insufficiency of the cardiac sphincter, due to which an incomplete distinction between the stomach and esophagus is allowed. The result of this is the frequent reflux of the acidic contents of the stomach into the esophagus, the epithelium of which is not adapted to such effects. In its lower third, a focus of inflammation is formed, a number of symptoms appear.
The first complaint of patients with a mild degree of GERD is a sensation of a coma in the esophagus and belching, sometimes accompanied by heartburn after eating. It is quite easy for the patient to associate the occurrence of such complaints with food intake. As a rule, they develop immediately or in the first 30 minutes after eating, are not accompanied by pain. Sometimes it also disturbs the feeling of fullness in the epigastrium and behind the sternum, heartburn, which is more pronounced, the more food was consumed and the more actively the patient moves and bends after eating.
A stereotypical symptom of patients with more severe GERD and its complications is frequent heartburn and belching with air. Vomiting is rare, it is not accompanied by nausea and, as a rule, stops immediately after separation of the meager portion of food eaten the day before. Often there is a sour taste in the mouth during the day and a feeling of bitterness on the tongue after sleep.
Such patients are recommended to eat 7-8 times a day in small portions and maintain a vertical body position for at least 1 hour after meals, to give up alcohol and smoking. Patients with GERD often suffer from unmotivated dyspepsia, which is why the consequences of taking alcohol are more severe. Smoking provokes an increase in gastric secretion and increases the rate of peristalsis, which is why the symptoms of belching and heartburn are felt more often and more acutely.
Due to discomfort, a feeling of heaviness in the abdomen or esophagus, as well as the effect of acidic contents on the esophagus, especially in small quantities, periodic hiccups and burping of air, this condition can be combined and treated by the patient as a lump in the stomach, esophagus or pharynx. Unlike a similar symptom caused by a neurosis or psychological stress, swallowing is free in this case, although appetite may be lost.
Gastric causes
You should also consider the gastric causes of coma in the esophagus, which at least the esophagus cause this symptom. Pathologies such as stomach ulcers, pyloric stenosis, tumors, or duodenogastric reflux disease are very common. Banal gastritis can provide frequent burping and discomfort in the esophagus.
Often the cause of this symptom is the presence of a tumor in the digestive system. Then, in addition to the sensation of a coma in the patient’s stomach or esophagus, weight loss, frequent nausea with vomiting after eating, hiccups, unmotivated chest discomfort after meals are disturbing. A specific symptom of gastric cancer is the aversion to meat food, which is observed due to the impossibility of its complete digestion and more acute manifestation of the above symptoms.
To identify the immediate cause of coma in the stomach, throat or esophagus, an examination is necessary. It consists of general clinical tests, examination of the lymph nodes of the body, x-rays of the chest organs, FEGDS. After identifying a specific disease, one should start its therapy.
Treatment before a specific diagnosis is also advisable, however, it will be non-core and will consist of PP inhibitors (Lansozol, Pantoprazole) or histamine receptor blockers (Ranitidine, Famotidine). Their use allows you to weaken the effect of the acidic environment of the stomach on the affected tissue of an ulcer or tumor, reducing the risk of bleeding.
Dysphagia
Dysphagia is a violation or difficulty in swallowing food associated with either a violation of the innervation of the muscles of the pharynx, or the presence of a tumor in the upper digestive tract. These groups of diseases can cause a coma in the esophagus when you try to swallow food, as well as bursting and discomfort in the chest. Outside of the act of swallowing, symptoms may either be absent, or the patient will feel heaviness in the chest and in the larynx, sore throat. A rare symptom is increased salivation and frequent unmotivated nausea.
In cases of significant obstruction of the lumen of the esophagus by the tumor, the ability to swallow food may be completely lost. Then, as a result of swallowing, the food comes into contact with the narrowing of the esophagus or pharynx, causing nausea and vomiting. Vomiting of unchanged food that occurs immediately at the time of swallowing is called esophageal. Its cause is the presence of a tumor in the esophagus or pharynx, mediastinum. Rarely, aortic aneurysm causes these symptoms.
With a paralytic form of oropharyngeal dysphagia caused by cerebral infarction or the consequences of traumatic brain injuries, a constant feeling of coma in the esophagus may be observed, associated with incomplete passage of food into the stomach. The solid components of swallowed food are constantly trapped in the throat or esophagus, causing mechanical irritation in the chest and neck, sometimes accompanied by nausea.
Dyspepsia
Dyspepsia is an episodic violation of normal digestion and motility of the gastrointestinal tract. It manifests itself as nausea, sometimes vomiting and loose stools, often causing a sensation of a coma in the esophagus and burping. Dyspepsia is associated with a violation of the standard diet and is more often observed in patients who already have some kind of digestive system disease.
Dyspepsia with gastritis is observed when eating fatty foods or when overeating, smoking, drinking alcohol. As a rule, sensing the onset of the above symptom of a coma in the throat, esophagus or stomach, the patient still does not know what disease or condition caused it. Therefore, when identifying such complaints, it makes sense to diagnose regardless of age to exclude tumor diseases and ulcers.
The detection of gastritis with FEGDS is the best outcome, which requires only proper nutrition, quitting smoking and alcohol. However, especially when detecting GERD or duodenogastric reflux disease, FEGDS should be performed annually for follow-up. This is necessary for the collection of biopsy samples and their study for the appearance of tumor cells.
Over the past 10 years, this practice has become widespread in the CIS, having already proven its effectiveness. In Japan over the past 30 years, the routine performance of PHEGDS with complaints of dyspepsia, nausea or a feeling of a coma in the esophagus after eating has saved hundreds of thousands of lives by early detection of tumor diseases before the metastasis stage.
Thyroid
The thyroid gland is located on the front surface of the cartilage of the same name. With its pathologies associated with an enlargement of the organ in size or the formation of nodes, the appearance of specific symptoms is noted, one of which is a lump in the esophagus. Treatment of thyroid pathologies, of course, is not based only on this complaint, in addition, in order to cause such severe symptoms, the increase should be noticeable externally. However, due to the fact that pathology data are often overlooked by patients, they should be considered in detail.
An increase in the size of the thyroid gland can be total or nodal in nature. In the first case, all iron increases in size, which is observed with endemic goiter or hypothyroidism. Nodular growth of the gland is observed more often, although less often this is symptomatic. Nodules are usually small in size, however, if they are located on the back of the organ, they can irritate the larynx. The patient feels discomfort and perspiration in the trachea and pharynx. Diagnosis is based on the exclusion of diseases of the digestive system, the ultrasound of the thyroid gland and the study of its hormones in the blood.
Mediastinal diseases
The mediastinum is the anatomical region of the chest in which the esophagus, ascending aorta, lymphatic vessels and nodes, lung roots, trachea, intrathoracic vessels, nerves and regional fatty tissue are located. This place is a close location of the organs of the cardiovascular, nervous, digestive, respiratory and lymphatic systems. And any defeat of them is manifested by a feeling of squeezing and discomfort in the chest, a sensation of a coma in the esophagus, belching. The reason for this is the close arrangement of neighboring organs, their contact and mutual influence on each other.
Among the most common diseases of the mediastinal organs, tumors of the main bronchi and lungs, as well as an increase in lymph nodes, should be distinguished. Aortic aneurysm is very rare, although its contribution to the formation of the symptom is often very significant. In case of the appearance of tumors or enlarged lymph nodes, mechanical compression of the esophagus is observed, which causes choking and discomfort when swallowing, difficulty in passing food, nausea and sometimes vomiting.
Damage to the lymph nodes occurs in diseases of the blood system (leukemia, hematosarcoma, lymphogranulomatosis, lymphoma), metastasis of tumors of the lung or main bronchi, breast, esophagus or stomach, as well as tuberculosis and sarcoidosis. Each of these diseases requires diagnosis and high-quality treatment in accordance with relevant protocols.
The psychological cause of the symptom
When a symptom such as a lump in the esophagus appears, the reasons, treatment and grounds for a thorough diagnosis of which are explained above, one cannot ignore any manifestations of diseases of the digestive, endocrine, lymphatic, cardiovascular and respiratory systems. And often with modern research methods it is impossible to identify a disease that can cause the appearance of such a complaint. In this case, when terrible diseases are excluded, it makes sense to look for the cause of a coma in the throat in the patient's psyche.
Chronic social stress, impaired patient adaptation to work and life conditions, as well as loss of loved ones, failure in relationships or business - all this can cause discomfort in the esophagus due to vegetative reactions. The so-called lump in the throat, approaching in moments of severe disgust, resentment, irritation, when a person, feeling powerless, wants to burst into tears and lower his hands, should be discussed with a psychologist. But this must be done either after the exclusion of formidable somatic diseases, or simultaneously with their diagnosis.
Summary
The sensation of a coma in the esophagus, the causes of which are described above in the relevant sections, is an important alarming symptom that cannot be ignored. Properly performed diagnostics will eliminate the appearance of formidable diseases or confirm their presence in the early stages of the ship. Delaying the diagnosis and trying to explain this symptom with psychological problems, which is also observed in many cases, does not lead to positive consequences. On the contrary, a quick diagnosis with general clinical tests, examination of the lymph nodes, performing FEGDS, fluorography, ultrasound of the heart and thyroid gland will allow you to quickly identify the cause of the symptom and begin to eliminate it.