Unusual Swallowing Sensations: Insights from Gastroenterology

I have a strange sensation when swallowing in my back?

Hello Doctor: I have been experiencing gastroesophageal reflux and a strange sensation in my back (around the scapula, possibly corresponding to the cardia?) while swallowing for the past two to three months.
This sensation usually occurs during the initial phase of eating and not in the later phase, and it does not feel like difficulty swallowing or pain.
Therefore, I mustered the courage to undergo an endoscopy yesterday.
The results showed that everything in the esophagus, stomach, and duodenum was normal, except that the endoscopy images indicated a slight whiteness at the cardia.
I would like to ask the doctor: 1.
The endoscopy images showed a slight whiteness at the cardia, and the outpatient doctor mentioned it could be due to aging or Helicobacter pylori.
Is this accurate, or could it be inflammation or another condition? 2.
If the endoscopy results are normal, could my aforementioned strange swallowing sensation be caused by very mild inflammation of the cardia or esophagus (too mild to be detected during the endoscopy)? 3.
Since the doctor wanted to confirm the findings, I underwent another endoscopy immediately, effectively having two endoscopies on the same day! After these two endoscopies, the strange swallowing sensation has become more pronounced today, and I even feel that my entire esophagus is somewhat odd.
Doctor, could this be due to injury from the endoscopy? If so, how long does it typically take for such an injury to heal? 4.
Finally, the outpatient doctor prescribed me medication for one week.
If I still experience the aforementioned strange swallowing sensation after finishing the medication, do you have any good suggestions on what steps I should take next? Thank you for your time and responses; I am a person feeling lost and close to depression.

Xiao Zhang, 40~49 year old female. Ask Date: 2019/03/21

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Current endoscopy has a very low probability of misdiagnosis or missed diagnosis for the esophagus, stomach, and the first part of the duodenum.
Please follow the physician's instructions for treatment.

Reply Date: 2019/03/21

More Info

Understanding unusual swallowing sensations can be quite complex, especially when they are associated with gastroesophageal reflux disease (GERD) and other gastrointestinal issues. Based on your description, it seems you have been experiencing a range of symptoms, including unusual sensations while swallowing, discomfort in the back near the shoulder blades, and a feeling of something being "off" in your upper abdomen. Let's address your questions one by one.

1. Regarding the white appearance of the cardia (the area where the esophagus meets the stomach): The observation made by your physician could indeed be related to several factors. The white appearance might suggest a few possibilities, including aging changes, the presence of Helicobacter pylori (a common bacterium associated with gastric ulcers), or even mild inflammation. However, without further diagnostic tests, it is difficult to pinpoint the exact cause. If there is a suspicion of H. pylori, a breath, stool, or biopsy test may be warranted to confirm its presence.

2. Could the swallowing sensations be due to very mild inflammation? Yes, it is possible that you are experiencing mild inflammation or irritation that is not easily visible during an endoscopy. Conditions like esophagitis (inflammation of the esophagus) can sometimes be subtle and may not always present with obvious findings during an examination. Additionally, the sensation could also be linked to esophageal motility disorders, where the muscles of the esophagus do not function properly, leading to unusual sensations during swallowing.

3. Concerns about potential injury from the endoscopy: It is understandable to worry about the effects of undergoing two endoscopies in one day. While complications from endoscopy are rare, they can occur, including minor trauma to the esophagus. If you feel that your symptoms have worsened following the procedure, it is essential to communicate this to your healthcare provider. Generally, any minor irritation from the procedure should resolve within a few days, but if symptoms persist or worsen, further evaluation may be necessary.

4. Next steps if symptoms persist after medication: If you complete the prescribed course of medication and still experience unusual swallowing sensations, it would be prudent to follow up with your gastroenterologist. They may consider additional diagnostic tests, such as a barium swallow study or esophageal manometry, to assess the function of your esophagus and identify any motility issues. Additionally, discussing your mental health concerns, such as anxiety or depression, with a healthcare professional is crucial, as these can significantly impact gastrointestinal symptoms.

In summary, your symptoms may be multifactorial, involving both physical and possibly psychological components. It is essential to maintain open communication with your healthcare providers, follow their recommendations, and seek further evaluation if your symptoms do not improve. Remember that managing gastrointestinal issues often requires a comprehensive approach, including lifestyle modifications, dietary changes, and sometimes psychological support. Your health is a priority, and addressing both the physical and emotional aspects of your condition can lead to better outcomes.

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