Mystery Choking
October 1, 2011 5:33 AM   Subscribe

Why does Mr. Llama's throat close up when he's eating?

He has already seen several doctors, including a gastroenterologist, for this, and there is no diagnosis. He has been through allergy testing (ragweed allergy that causes his face to swell if he's exposed to raw zucchini) and an upper endoscopy, which found nothing, though they gave him a prescription for Prilosec anyway. The prescription went forgotten until a as I was typing this asked him where the medication they'd given him after the endo had gone (it had been misplaced).

So the Prilosec is untried, but taking two pills a day, forever, for something without a diagnosis isn't terrifically appealling.

His description of what happens is: while he's eating, his throat closes up and he can't swallow. This lasts thirty seconds to a minute or two. It is scary. It always happens when he's eating, and might be breakfast, lunch or dinner. It does not seem related to any particular food, and actually happened once when he was drinking a Pumpkin Ale. Once it happened as he was eating the exact same cereal he'd been eating for about two hundred days in a row. Once, it made him throw up spontaneously. It happens about three times a week, and often happens when he's rushing. To be clear about the last, Mr. Llama's not a shovels-food-into face type of person. He is not overweight and is generally quite healthy. He exercises on a regular basis and eats reasonably well. He could, in fact, probably use less work-related stress.

1) What is it?
2) What tests can be done?
3) What are the specific things that we need to pursue to get it resolved, if it can be resolved?
posted by A Terrible Llama to Health & Fitness (21 answers total) 4 users marked this as a favorite
 
Sounds similar to my asthma-related acid reflux. Nexium has helped, as has watching my trigger foods and treating the asthma. Good luck.
posted by Lieber Frau at 5:49 AM on October 1, 2011


I also take Nexium everyday for an unexplained pain/feeling like choking/need to burp but can't and the difference from the 3rd day of taking the drug is amazing! I was actually scheduled to have my gallbladder removed in 3 weeks as a "hopefully this helps" kinda thing which I am now cancelling because the pill is so effective. Don't know if this applies but I thought my pain had nothing to do with gas/reflux as there is none of the classic signs including burning and what triggered the reaction was totally random. The exact same lunch one day would be fine but not 3 days later. Good luck.
posted by saradarlin at 6:05 AM on October 1, 2011


Has he seen an ENT? Prilosec is a racemic mix of omeprazole; Nexium is a considerably more expensive version of omeprazole that is only left-handed. So it can't hurt to try the cheaper Prilosec, though it will take a few days for its effects to kick in.
posted by Blazecock Pileon at 6:05 AM on October 1, 2011


And by a few days, I mean that he would take the medicine as dosed for at least a few days, not once and then wait.
posted by Blazecock Pileon at 6:24 AM on October 1, 2011


He should definitely see an ENT. A close family friend had choking sensations/difficulty swallowing, did his damnedest to ignore it and "get by", and eventually developed aspiration pneumonia from swallowing tiny bits of food (not enough to cough or choke) into his trachea and had to be hospitalized. Extensive testing showed permanently weakened throat muscles (esophageal dysphagia); eventually he was fitted with a g-tube and learned to self-administer liquid nutrition directly into his stomach. This gentleman was in his late 70's when diagnosed; possibly a younger person with the condition could do something corrective to strengthen the throat muscles?
posted by RRgal at 6:30 AM on October 1, 2011


My dad had this issue where often if he ate to quickly, sometimes with ... sticky foods, his throat would clog up, and he found himself in danger of not breathing. Sometimes he had to puke to relieve it. This sort of sounds like your description.

He mentioned this to the doc at his 50yo colonoscopy, and while he was anesthetized they also went down his throat, and stretched a little band that can restrict food from being swallowed--now he has no problem.
posted by tintexas at 6:36 AM on October 1, 2011


I used to get this 'my oesophagus has closed and food will not go down' sensation. It was usually with the second bite of food. It was more acute if I was eating more quickly because I was really hungry. I take nexium now and never get this anymore. A endoscopy confirmed it wasn't anything Very Bad, and was likely acid reflux irritating the oesophageal lining and narrowing the passage.

IANAD but am sitting in one's office unsupervised... (really!) If it is helpful he can start with daily tablets and taper down (I now only take two or three a week)
posted by Trivia Newton John at 7:08 AM on October 1, 2011


I've had bouts of not being able to swallow/mystery choking for several months at a time, and then it would go away. Did a bunch of tests and nothing was found. I've concluded it's caused by anxiety.

My mother had it in her thirties as well and it similarly went away by itself.
posted by Dragonness at 7:57 AM on October 1, 2011


Seems like a no brainer for him to at least try the Prilosec, really. He should give it at least a week or two on the Prilosec to see if that might help.
posted by gudrun at 7:58 AM on October 1, 2011


Obviously, you'll want to check every possible physical cause, but I will say that someone I know has something similar. If they are stressed (especially time-stressed) and anxious (especially about something they are soon to be dealing with), they will get coughing/choking/throat closure to the point of throwing up several times – and it might not even be a super big thing that they are stressed about.

It could be doing a job they are super confident about, but with a new group of people, or any launch of a new project, or any looming deadline, or a schedule conflict ... or even less of a prompter, sometimes. Coffee makes it worse. Plus, it's kind of on a feedback loop: the more it happens (for any single incident), the more it happens. Talking about it at the time makes it happen more.

I don't know what this is, but I have a feeling it's something akin to jaw clenching, or teeth grinding. This is totally and merely anecdata, but I simply wanted to say that if physical examinations don't reveal a specific cause... it could be somehow psychosomatic (whatever that really means). I've had some pretty crazy stress-related physical problems, ranging from migraine and completely debilitating backache to chest pains and hives.
posted by taz at 8:35 AM on October 1, 2011


If the Prilosec resolves it, it's probably GERD-related. My mom has this and is on the two-pills-a-day routine. I don't have the choking, but similar esophagal issues and also take my two pills a day. I'm a big fan of better living through chemistry and just add them to my morning vitamin routine.
posted by MsMacbeth at 8:55 AM on October 1, 2011


I have dealt with this exact phenomenon for about 20 years and last year got to take an ambulance ride to the ER because of it. After that my doctor prescribed a miracle pill that I can dissolve under my tongue when I feel trouble starting. In my case the problem is caused by an intense esophageal spasm brought on by a bunch of annoying contributing factors. Same story: it feels like someone closed the shutoff valve at the bottom of my esophagous. After my last super-intense episode (the pain knocked me off my feet in the middle of a restaurant) I was also given something from the Prilosec department for a few weeks to calm stuff down an give the lower esophagous time to heal.

I'm traveling so I can't go read the name off the pill bottle - MeMail me if I haven't updated this by tomorrow night.
posted by range at 9:11 AM on October 1, 2011


When I was younger, this happened to me. It ended up being anxiety-related.
posted by KogeLiz at 9:25 AM on October 1, 2011


This happens to me and my dad sometimes. It's anxiety related. A really low dose of xanax does wonders, like half of a .5 mg pill.
posted by capnsue at 9:30 AM on October 1, 2011 [1 favorite]


Have you seen a neurologist? Not trying to freak you out, but it's something to look into if you haven't found any other solutions. It could also be anxiety.
posted by Nattie at 10:51 AM on October 1, 2011


The esophagus is a muscular tube and can spasm closed. This can be triggered while eating, very especially in people with reflux. It's a lot like having someone squeeze a hand around one's esophagus. And yes, it can cause vomiting or aspiration.
Have him try the prilosec. If it works-great. If not-ENT.
posted by SLC Mom at 11:03 AM on October 1, 2011


If it happens frequently enough that it could be observed while you are eating in front of a doctor/speech therapist at a planned time for a test, you might want to have him look into a "modified barium swallow study". Speech therapists in rehab or hospital settings are also trained in issues of feeding and swallowing. A modified barium swallow test allows a doctor and speech therapist to observe a patient with an x-ray while he or she eats foods of different textures. They video-tape the study and can look at both sides and a frontal view. I observed several in graduate school, and sometimes they didn't catch anything, but did observe a hiatal hernia from acid reflux.

It might be overkill if you have already seen doctors about it, but it is the gold-standard for swallowing related issues. You might have trouble getting a referral for one, though. I think the idea of seeing an ENT is probably a good next step after a general family doctor.
posted by shortyJBot at 12:06 PM on October 1, 2011


This happens to me, and with me I'm pretty sure it's stress/anxiety. It can be quite painful, like food just gets stuck and won't go down. I've had tests, but nothing physical's come up. I've not found a proper fix.
posted by ComfySofa at 12:38 PM on October 1, 2011


IANYD (nor am I a gastroenterologist) but you could certainly ask his doctor about a barium swallow study - it allows you to see what the food or drink is doing in transit.

The "miracle pill" treatment mentioned above for esophageal spasm is nitroglycerin.
posted by treehorn+bunny at 7:46 PM on October 1, 2011


Response by poster: Thanks everybody; this is helpful and gives Mr. Llama some practical things to try.

For what it's worth, he already did the barium swallow thing....At this point it seems like it most likely is rushing and stress (in the absence of anything else) as a couple of people mentioned, but it also sounds like whether or not that's true, the Prilosec is worth trying for a while. It's actually just helpful to know that others have experienced this, even if it doesn't have a name and doesn't have a 100% certain treatment.
posted by A Terrible Llama at 9:32 AM on October 2, 2011


Response by poster: He got a diagnosis!

He has to use an inhaler for six weeks and that should theoretically kill the knee-jerk immune response from what is, apparently, an allergy.
posted by A Terrible Llama at 8:27 AM on October 27, 2011


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