Diverticulum or Stricture?

In My Humble Opinion
1

So, since about high school I’ve been plagued with nasty heartburn and food getting caught in my throat. Back then, I figured the food getting caught was just me trying to eat too fast and the heartburn was heartburn…didn’t think too much of it. 15+ years later, it’s still happening. The heartburn is worse (but I know the triggers), food gets caught more often and I can barely swallow pills without them getting stuck. And no, it’s not ‘in my head’, I can ‘swallow’ them, but they don’t make it far. And when things get stuck in my throat, I can’t take a sip of water or have a bite of bread to push it down. I just end up with more stuff piled in there. It’s an odd feeling. Painful, but not overwhelming, choking sensation, but I can breath and talk. The only way to get it out is to get it to come back up. Every once in a while, it’ll slide down on it’s own, but that doesn’t happen reliably enough to count on. As soon as something gets stuck, I know I’m going to have to deal with it.

I kinda self diagnosed myself with a stricture a while back, probably due to the really bad heartburn I’ve had for the last 15 years or so. That is until someone mentioned the word diverticulum, which I’ve never heard in reference to this. So that gave me lots of new stuff to read about (ie Zenker’s).

For the last few years, I’ve always told myself that if I ever hit my deductible, I’d go and deal with this issue, assuming I could just get the stricture dilated. Well, I hit my deductible last year on December 23 (kidney stone) so that wasn’t really enough time to do anything about it. Then, last week I was at my ENT’s office and I just happened to be talking to him about it and he told me he’d be more then happy to call in a barium swallow for me, so that at the very least we could see what’s going on. I think I’ll try to get that scheduled at some point soon. Of course, I haven’t even started getting the bills from the kidney stone stuff yet.

I’m hoping for a stricture, the dilation procedure seems a lot less painful then the procedure for getting rid of/opening up the diverticulum. Just going by my symptoms, I can’t really tell which why it might go. The only thing that sways me towards Zenker’s is that sometimes I can feel something get stuck in my throat, but not totally block my esophagus. For example, today, I ate something and for the next few hours, every swallow I took, I could feel something in there, a sip of water made the characteristic gurgling sound as it went down, but I could still eat other food just find. That makes me think that something was caught in a pouch and other things were still slipping past it.

I remember way back when I was younger, telling my mom that it felt like I had something caught in my throat and she would tell me that sometimes if something scratches your throat on the way down it might just be irritated and feel like something’s caught there. Sometimes (like after eating chips and know that happened) it made sense, but even then, I knew it was happening too often for that to be the answer.

My concern is that they’ll find nothing at all. Even if I choose not to get it fixed, I’d at least like to have an answer.

Anyone else have any experience in this area?

2

Well, a GI doctor (gastroenterologist) should be able to diagnose it at least. I’ve had two diagnostic procedures, and they came up with encyclopedic lists of problems I have.

(1) You drink some chalky glop, and they take X-rays as it goes down.

(2) They put you to sleep, or nearly to sleep, then stick a tube with a camera down your gullet and take a look. Since you are sedated, it’s not an obnoxious process. While there, they may also take samples from your stomach and maybe even some tissue snippets to be biopsied to see if you have any loathsome diseases (like cancer or C. difficile).

I assume if they do any corrective procedures, they must also sedate you for that, so it might also be not-to-obnoxious.

3

You don’t have to be sedated for an endoscopy - I had one of mine fully awake, just a bit of anesthetic (tasted like banana) on my throat to suppress the gag reflex.

I burped a lot.

Si

4

Oh, and see a Gastric specialist. I have a Schatzki ring and Hiatus Hernia but have never had any treatment - the hiatus repair wasn’t worth the risk (the specialist said there were better than even odds that it would be back within 5 years) and I manage the other symptoms. And they are much better once I lost significant weight.

I have the problem with spasms, where the bolus gets stuck. My specialist’s advice was to always have a drink available when eating - water, or something slightly fizzy (he suggested Kingfisher beer, I choose 50/50 lemonade/fruit juice). It works for me, but get it checked out. Rice, chicken, bread can all be problems. Chew thoroughly and sip water.

Si

5

I had an esophageal stricture. When I proved utterly unable to swallow some Chinese food, or get it back out, for about five minutes – a fairly scary incident – the general practitioner I used at the time said very matter-of-factly, “Stricture, most likely,” then sent me to a cardiologist and some other specialist, before finally sending me to a gastroenterologist, who after interviewing me and reading my cardiac data finally was the first person to LOOK down my throat.

“Oh, I can see it,” he said, confirming the GP’s off-the-cuff diagnosis. I have no idea why it took a fourth doctor before anyone looked.

I underwent a balloon dilation. It wasn’t painful, but I was on a Demerol drip (which was supposed to leave me “conscious but uncaring” during the operation), but my gag reflex overpowered the level of sedation, so they turned the Demerol drip “all the way up” and knocked me right out. I very vaguely remember some thrashing and then I woke up in another room a lot later. :stuck_out_tongue:

I did have Demerol withdrawal the next day, though, which was actually pretty rough.

I am now on “proton pump inhibitors” for the GERD (gastroesophageal reflux disease – heartburn). My current doc recently moved me to Nexium, which is supposedly more powerful than the Protonix or Prilosec I’d previously used, and it seems to be helping more.

You should definitely get treated – persistent heartburn / GERD can lead to serious issues, including cancer.

6

I have hearburn regularly. After an endoscopy my gastro doctor said I have a slight hernia. Esophagus is fine, as long as the antacids work no reason for me to do anything about it.

I also decades ago was getting pains in the center of my chest. A visit to a cardiologist ruled out any problems in that department, and my doctor told me I was having spasms (this is not the right word but I don’t remember the exact term) in the esophagus, possibly caused by stress. Recommeded Mylanta.

Bottom line, as with most medical things, there can be a lot of possible reasons from a single symptom, ranging from trivial to hideous. I concur that you should see a gastroenterologist or similar specialist. Yeah, it may cost you, but there are lots of situations when addressing an issue early is far less costly than letting it go untreated.

7

Chicken is actually one of the things that regularly gets stuck. One of the other things I recently have written off (didn’t write off chicken BTW, just have to be careful) is quinoa. Yes, I know “but it’s so small”, but for some reason, maybe something to do with the way it clumps up, it gets caught. Tried it twice, got stuck twice. I like it, but not that much.

Also, drinking something fizzy wouldn’t work, when something is stuck, nothing gets past it. Swallowing a liquid just makes my throat go through the motions, but it doesn’t actually push anything down (and it’s really painful to try).

As far as beer, beer is my biggest heartburn trigger right now. A few sips and I’ll be dying about 5-10 minutes later. I’ve all but given it up. I’m usually okay with domestic/light stuff, but I can’t drink craft beer anymore.

8

I keep meaning to update this, but then keep forgetting and while searching for something else I ran across it.
So, I had the barium swallow. It was no big deal at all. In fact, the worst part of it was swallowing the fizzy stuff they give you to distend your stomach. They had me take maybe ten or so big gulps and I heard the doctor say “He’s fine” and they told me to stop and that was it.
When I went back for the follow up with the ENT, he said, as I expected, that they didn’t find anything.
I told him that that was a bit of a let down and that I was hoping they would find a stricture so they could fix it. According to him, that would be worse since those just need to get redialated every year or two (which I’ve heard).
Now, I had asked three people (someone at the doctors’s office, and two people at the radiology place) if I could eat before and they all said yes. I had a very light breakfast because I didn’t want to fill up and be to full to eat or drink whatever they gave me when I got there. Well, when I went in, I felt like I had something caught in my throat already. Not some giant wad of food or anything, but something none the less. So, I keep wondering, if I do have a diverticulum, if the barium shake wouldn’t have gone into it if there was already something there? Or maybe that’s not how it works.
Also, for an added bit of fun, when I said to my ENT “Well, there’s something wrong, where do I go from here?” he put a camera up my nose and into my throat, so that was a new feeling. Didn’t find anything there either.

As far as he’s concerned, everything is totally normal, but I should still see a GI person to get the heartburn under control. I do have it pretty under control with Prilosec and staying away from things that trigger it, but, it would be nice to be able to not worry about eating or drinking certain things and even nicer to someday not have to take Prilosec everyday. Oh, and even better if I didn’t get food stuck in my throat all the time. Which reminds me, my ENT did say that in all likelihood, it’s just something I’ll have to deal with, that I’ll just really have to pay attention to how well I’m chewing my food and always be careful that I’m not swallowing too much at once. According to him, some people aren’t athletic, some people don’t have good penmanship, I don’t swallow well, it’s just the way I’m built.

I get the feeling a GI guy, right off the bat is going to want to put me on Nexium, which, with my insurance plan, is about $125 a month, something I’d rather not do right now and I’ve read that it tends to not be that much better then Prilosec.

9

Minor update. I had a endoscopy today with the plan of dilating my esophagus and checking out my stomach to see if there was anything going on to cause the heartburn.
Turns out my esophagus is so narrow I’ll have to go back when they can get a pediatric endoscope, they didn’t have one at that hospital and they couldn’t get this one down more then a few inches.
So at least that validates the whole pill and food getting caught in my throat thing.

Hopefully I can do that in the next few days or week or two.

10

I just got a PM from someone asking me (new member, possibly related issues) about this so I should probably update it.

When I first met with them they suspected something called eosinophilic esophagitis (EE). Frankly, I was a bit worried that she was trying to fit my symptoms into a pet diagnosis, but whatever, I wasn’t worried, I wanted the EGD anyways. When I came around after EGD and was told they didn’t get anywhere I was a bit disappointed but he said the took a biopsy to check for EE and they’ll get back to me.

I did some research on EE and found that to be diagnosed for EE you have to have more then 15 eosinophils per high-power field. My understanding is that when they looked at the sample under a microscope they needed to see at least 15 of a certain type of white blood cell. I watched for my results to show up online and it said that there were “greater then 30”. So yeah, I have it.
They started me on “swallowed Flovent” It’s an off label use where you spray an inhaler into the back of your mouth and then swallow it. The idea being the the steroid goes down your esophagus and reduces the inflamation. He had me do this for a few weeks and then went in for a second EGD. After that one he said it looked better but only managed to dilate me halfway and had me do one more. I did that one just a week or two ago. I’m finally able to swallow larger pills…at least some. I don’t have a whole lot of big pills around my house since I always avoided them. I haven’t had any food caught in my throat in weeks, so that’s good, even foods that should get stuck haven’t been an issue.

Next, they had me go to an allergist since they [the medical community] is working under the assumption the EE is caused by allergies and more specifically food allergies. I went and got prick tests and while I never thought I was allergic to anything the doctor and nurse were surprised that I seemed to be ‘allergic’ to damn near everything and appeared to be surprised that I wasn’t clawing the skin off my back. After I told them that I’m NOT allergic to potatoes or carrots or peanuts etc they explained to me that it’s not that I’m allergic in that I’ll break out in hives or go into shock, but I’m just sensitive and maybe it’s that I’m just sensitive enough that 35 years of eating those things have caused my esophagus to swell enough to make eating difficult. They also confirmed something that I learned here…I do have Oral Allergy Syndrome with a cross reaction to Birch. I came up positive for several of the items listed for birch but not apples. Apples do cause an itchy throat for me but he said it’s common for something to cause a reaction in someone when they eat it but not on the prick test WRT OAS.

He seemed VERY excited to have me as a patient, I think I’m his second EE patient. He [the allergist] did go a bit overboard though. He consulted with doctors in Madison, WI and Indianapolis trying to come up with a game plan and in his perfect world he would have me go off of everything I’m allergic to, do a EGD with a biopsy, make sure the eosinophils are at 0 (or whatever they should be at), then reintroduce foods one at a time for a few months with EGDs/biopsies each time to check the eosinophil count and see if the EE is coming back. While that would find out exactly where the problem lies, I told him it’s a bit to aggressive. Each EGD is $4000 and a day off of work and I don’t think my insurance is going to cover those ones. I did say “Hey, keep your eyes open for a study, if someone wants to do all those EGDs for free and pay me a few grand, I’d think about it” and I would.

In the mean time I’m thinking about doing allergy shots. It’ll help with regular allergies, oral allergies and we don’t know that much about EE but it may very well help with that.

Whew…any questions?