Where is my food going?
December 22, 2006 7:26 PM   Subscribe

Why is my food not making it to my stomach?

Sometimes food does not go down correctly when I am eating. This is not the same as when it “goes down the wrong pipe” and causes coughing or a choking feeling. Instead this seems to stick in the upper chest area somewhere, almost as though it is just sitting there. If I notice this is happening quickly enough, I can simply breathe slowly and relax without trying to swallow and I can feel the food work back up as though it is crawling up my esophagus. It then goes down normally and I can continue eating, usually without any more problems. If I try to swallow while this is happening (which is a reflex and it is hard to avoid) it keeps the food wherever it is going and it does not work back up.

Also if I do not catch it after the first bite that does this, the food seems to compact somewhere and I start to feel tightness in this area and I end up forcing myself to dry heave until it comes up. I can feel the food in my upper chest and I can feel it coming up when I do this. I should note that there is never a bile taste or any noticeable acid coming up with the food or any feeling that I am bringing anything up from my stomach, it is all in my upper chest.

I am unable to eat or drink anything until I forcibly gag the food up if it does not work back upwards on it’s own, otherwise it just continues to pile up. My nose starts running profusely as does saliva, which goes to join the food. So I end up gagging up a wad of food and a bunch of saliva and sinus drainage. It can be painful and if it is a bad case, it leaves me unable to eat for anywhere between thirty minutes to a few hours because the food keeps going the wrong way for a while. I have had to leave restaurants before because of this happening bad enough that simply going to the bathroom and trying to make it come back up was not enough.

It seems to happen most often when I am exhausted or when I go for a while without eating anything. I have found that steak and roast beef are by far the worst culprits. I asked my doctor about it on two occasions and once he said it was nothing to worry about and another time I was there for a cold and he outright refused to talk about it, saying I needed to worry about the cold and not anything else. I haven’t bothered asking again. I have read about GERD and other similar problems but haven't found anything exactly like this.

Any clue?
posted by weretable and the undead chairs to Health & Fitness (25 answers total) 9 users marked this as a favorite
I've heard of people who have a problem of their normal action being slightly backward; sounds like you're another one. You prolly need to see a doctor about it.
posted by Doohickie at 7:32 PM on December 22, 2006

Try googling for any of the following terms:
- Esophageal web
- Esophageal stricture
- Esophageal ring
- Achalasia
- Esophageal dysmotility.

Basically, you could either have a narrowing of the food tube due to a number of different causes, failure of the food tube to open into the stomach, poorly coordinated peristaltic food tube contractions that propel the food downward, or a rigid food tube. Basically.

Your physician is a poohead for not addressing your concerns. I hope you'll find someone more willing to work with you. Once you do, you'll be asked a bunch of important questions to further elucidate the nature of your problems.

Diagnostic studies might include sticking a fiber optic camera through your nose and down your throat to see what's going on. You might also be asked to drink some contrast and get some x-rays taken to see if there's a narrowing in your esophagus. Finally, studies which measure the pressure along the length of your esophagus might be in order.
posted by herrdoktor at 7:45 PM on December 22, 2006 [2 favorites]

My wife suffered from a similar problem for years. It was finally diagnosed as GERD (reflux). The doctor gave her nexium and she lost some weight and no problems. But if she gains a few pounds it causes problems again. It was so embarrassing for her when we would go out to eat. So many times she had to go to the bathroom and cause a gag to get the food out. And beef was the top problem. She was persistent with her doctor and did get relief. I feel for you. It is an awful discomfort I know.
posted by JayRwv at 7:52 PM on December 22, 2006

Here's a few things that the doc will throw on the differential diagnosis: constricted esophagus, GERD--possible esophageal hernia; have you had any other surgery recently or worked out enough to build up mass that would constrict the esophagus any? quite possible.

On another note, someone else mentioned it and yes that doc isn't addressing your concerns, find someone else.
posted by uncballzer at 7:59 PM on December 22, 2006

Never one to falsely reassure but my wife had (has) exactly thw same symptoms you described. After extensive testing ti make sure there was no anatomical pathology she was put on a medicine and the symptoms disappeared. She no longer takes the medicine and occasionally experiences some problems. Hers is worse in the morning and aggravated by alcohol. Best Wishes
posted by rmhsinc at 8:01 PM on December 22, 2006

Oh man! I have this same exact problem! I just chalked it up to having a small esophagus or something (heavy on the or something) and just accepted it. I've had to go to the restroom many times to force a bite up if I didn't think a few swallows of water would do it, and I've even required the Heimlich once: VERY scary.
posted by rhapsodie at 8:09 PM on December 22, 2006

* Heimlich required because I thought I could force the bite down with a gulp of water, and the water just filled up my esophagus so that I couldn't breath. In a small yet crowded Thai restaurant. Extremely disgusting and embarrassing.
posted by rhapsodie at 8:11 PM on December 22, 2006

My girlfriend, who works with speech/language pathologists, says that many of them are also qualified to treat swallowing disorders. (After all, they're experts on how you should or shouldn't use your tongue and throat.) She says that you should contact a speech and hearing clinic in your area and see if they can point you in the right direction.
posted by nebulawindphone at 8:16 PM on December 22, 2006

I get this sometimes when i'm eating too much too quickly. Try taking smaller bites, consciously, even if they seem ridiculous.
posted by softlord at 9:02 PM on December 22, 2006

Any doctor who ignores your concerns is a quack. Get a new one.
posted by dirtynumbangelboy at 9:23 PM on December 22, 2006

Don't know if this helps, but I get a similar feeling (but not such extreme symptoms) when very, very tired and/or dehydrated. (They're probably linked.) I now know not to eat -- anything -- after working out for a long time or exerting myself outdoors on a hot day, until I know I'm thoroughly puffed back up with plenty of water.
posted by turducken at 9:31 PM on December 22, 2006

As a kid, I used to get this with raw carrot; the stuff would simply not go down my throat. I didn't particularly dislike raw carrot - my throat simply wouldn't swallow it.

These days it only happens if I try to dry-swallow a too-large pill; the oesophagus just seems to go on strike, and the pill just sits there clogging everything up until it dissolves of its own accord. It's painful and nasty. Carrot isn't a problem any more, simply because I've learned how to bite off smaller bits and chew them properly before I swallow.

So it could well be something as simple as insufficient lubrication. Roast beef can be pretty dry; try consciously taking smaller bites than you normally would, and chewing for longer, and see if that makes for an improvement.
posted by flabdablet at 10:45 PM on December 22, 2006

I've had some similar issues. I have an esophageal ring (aka a Schatzki Ring) that caused food to get stuck, particularly when eating starchy stuff quickly without drinking. Steak is often a common culprit with this problem, hence the use of the term "Steakhouse Syndrome" in referring to this difficulty swallowing.

I've twice had this ring dilated (blogging about it once). Dilating the ring fixed the problem of stuff getting stuck at the ring. And yet in my case there was a *separate* problem of stuff coming up somehow without my even having known it was stuck. This is known as "rumination syndrome," according to my doctor. Apparently it is mostly harmless and perhaps stress-related, but it is not so well understood. (In fact many swallowing issues and problems seem to be poorly understood).

You should see a better doctor. (I'm not a medical doctor of any sort, obviously). There are some potentially dangerous conditions associated with swallowing difficulty, including the formation of pouches etc. where food can get stuck, but which are also subject to rupture. (I worry about this in my own case, since despite two endoscopies and a barium swallow, I know that bubbles still seem sometime to get stuck in my esophagus, leading to discomfort).

Ok, but enough (too much!) about me. My bet is that in your case there's simply a Schatzki ring in your esophagus that needs to be stretched out.
posted by washburn at 11:19 PM on December 22, 2006 [1 favorite]

Do you ever get hiccups? Have you ever tried the remedy of trying to swallow a tablespoon of dry granulated sugar? For normal people this is pretty hard and the irritation caused by the grains sometimes overrides the lower hiccup irritation and suppresses it.

People above have mentioned problems swallowing things because they are irritating. But I have never heard of any problems swallowing water (as long as you are not trying to chug it).

Anyway, the question is whether you have a problem of physics (restricted esophagus or something else) or whether your esophagus is easily irritated and freezes up. Trying a "spoonful of sugar" might tell. I would suggest that you start experimenting with a small amount - the standard cure of a heaping tablespoon might throw you into a fit.
posted by MonkeySaltedNuts at 11:30 PM on December 22, 2006 [1 favorite]

I have lots of Googling to do. I intend to see a doctor about this sometime next year after I have a bit of cash again.

I get the hiccups sometimes and I have used the sugar remedy although it does not work for me most of the time.

I have not had any surgery or other problems with my esophagus and whatever this is, it didn't start bothering me until my mid-teens (28 now) and it has occasionally happened with something really soft and easy to swallow like jello, but it is usually roast beef or steak or something similar to that.

It happened to me tonight when I was eating with my family after Christmas shopping, which is why I ended up posting this question. But the first thing that "stuck" was a piece of broccoli. I had a steak and grilled vegetables and I ate three or four pieces of the vegetables and then a couple pieces of steak before I realized it was happening. I went to the bathroom, couldn't get the food to move or the pressure to let up and was miserable. I had to leave the restaurant and asked my family to get a box for the majority of my meal and bring it to me later since I was anxious to get out of there.

It took a while to get all of the food and drink up after I got home, probably one of the worst incidents I have had. And I didn't think my sinuses were ever going to quit draining. It made me decide I needed to see about getting something done about though.
posted by weretable and the undead chairs at 12:01 AM on December 23, 2006

It could be a Tracheoesophogeal Fistula (a connection between the trachea and esophagus). If so, it appears safely treatable (see this link for more detailed information). I definitely agree with all of the other people who have suggested that you find another doctor - what you're describing is clearly not normal.
posted by concrete at 12:42 AM on December 23, 2006

I can get something similar to this when I'm eating rice or bread too quickly. Washing it down with water and holding my chin up works for me, although it doesn't feel too pleasant.
posted by stereo at 1:35 AM on December 23, 2006

My mom has something similar. In her case her esophagus tightens before it gets to her stomach, almost like a funnel. She mentioned that untreated, your esophagus can expand to the size of your stomach.

I dunno about medical treatment, but I know that for my mom eating chocolate (i belive dark chocolate) throughout the day helps her throat relax and gives her less problems when eating.
posted by allthingsfixable at 10:00 AM on December 23, 2006

I'd certainly suggest trying another doctor; if possible, see a specialist. My experience is that many general practitioners quickly fit symptoms to common ailments, which is a half-decent heuristic that's helpful to a large number of people ... and not so much to others. Specialists seem less quick to do this and more ready to try testing to narrow down possibilities.
posted by weston at 10:22 AM on December 23, 2006

Your vivid description evokes an image of an esophagus with a branch off the main passage which is a blind alley. It sounds as if this blind alley is most often closed, but opens occasionally, possibly when the bolus of food is large enough to force it open, as might be expected with food like beef, which is difficult to chew thoroughly. After it's open, it takes a while to settle down and close back up. (This explanation is a minor variation on the "pouch" suggested by weston.)

Esophageal malformations are associated with Arnold-Chiari malformation, which is associated with Spinda Bifida. In your most recent previous question, Asking why your right arm goes numb sometimes when you sneeze, Diddly said the same thing happened to him, and that he attributed it in his case to his Chiari malformation.

I think these two things taken together ought to point you in the direction of a careful evaluation for Chiari malformation and attendant disorders. If you have this, you probably have the often asymptomatic Type I, but that type can cause severe problems later in life, particularly in combination with other medical issues, and surgical alleviation is a possibility.

The sinus drainage and salivation you get when this happens to you is especially interesting; it suggests to me that when a person gets something stuck in the esophagus, the body, not content to rely on fortuitous proximity to a glass of water, has a built in response to provide fluid and lubrication to resolve the blockage.

I wonder how often, chronically and acutely, sinus trouble could be traced back to something going on in the esophagus.
posted by jamjam at 12:18 PM on December 23, 2006 [1 favorite]

Key questions: 1. How old are you? 2. How long has it been going on? 3. Do you have any other medical conditions? 4. Does it happen all the time, or very rarely? Not trying to defend a doctor who is blowing you off, but the answers to those four questions might determine how worrisome this is. Most doctors have 15 minutes scheduled with which to see you and maybe you had other medical issues to discuss while you were there?

Common things being common, it is probably esophageal reflux. However, possible explanations for this condition (called dysphagia) range from post nasal drip to esophageal cancer. In a world where you have good medical insurance and unlimited access to medical resources and time, the next step is probably getting an endoscopy, a fiber optic camera is inserted under anesthesia through the mouth into the esophagus and stomach. An upper GI series (swallowing barium contrast and having xrays taken of your esophagus and stomach) also provides information. If you are trying to do this on the cheap and easy however, take Prilosec OTC for a couple weeks and see if it gets better, realizing that you need to get more tests done if you want a definite answer.
posted by Slarty Bartfast at 1:23 PM on December 23, 2006

Since everyone has already covered the terrifying things that could be wrong with your foregut, let's not forget to mention "globus sensation," which is essentially the feeling that there is a blockage in your throat when you go to swallow.

It's a neurotic manifestation of anxiety and not otherwise dangerous at all; and it accounts for most complaints like these in otherwise healthy young people.
posted by ikkyu2 at 2:16 PM on December 23, 2006 [1 favorite]

As an x-ray technologist who often does diagnostic procedures for these types of symptoms, I'd say it's most likely GERD. You'd need an endoscopy and/or a Barium swallow procedure to diagnose and get treatment.
posted by NSSG at 5:33 PM on December 23, 2006

This news item isn't particularly helpful, but I thought it was interesting that swallowing problems are an issue for a lot of people during the holidays.
posted by saffry at 4:21 PM on December 24, 2006

As a footnote to ikkyu2, mom is 86, and she calls hers "a charley horse of the esophagus". She's learned to deliberately relax and wait, and it sorts itself out. (I don't think she drinks water with hers, it seems to complicate the issue.) She's had it for maybe 50, 60 years, and I think she mentioned to a doctor once, but he wasn't interested, and she never bothered to bring it up again. It's probably his "globus sensation"; I must email her that it has a name, she'll be delighted.
posted by unrepentanthippie at 8:36 PM on December 24, 2006

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