Can esophagitis cause a foreign body sensation?

Esophagitis Can Cause Foreign Body Sensation

Yes, esophagitis can definitely cause a foreign body sensation in the throat or esophagus, which is a common clinical presentation of this condition. 1 This sensation is part of a constellation of symptoms that patients with esophageal inflammation may experience.

Pathophysiology and Clinical Presentation

Esophagitis leads to inflammation of the esophageal mucosa, which can trigger various sensory symptoms including:

• Foreign body sensation - A feeling that something is stuck in the throat or esophagus even when no actual foreign body is present 1
• Dysphagia - Difficulty swallowing
• Odynophagia - Painful swallowing
• Retrosternal pain - Pain behind the breastbone
• Sore throat

The foreign body sensation specifically occurs because inflammation activates sensory nerves in the esophageal mucosa, creating the perception of something being present when there isn't actually a physical object there.

Types of Esophagitis Associated with Foreign Body Sensation

Several types of esophagitis can present with foreign body sensation:

1. Eosinophilic Esophagitis (EoE)

• Most strongly associated with foreign body sensation and food impaction
• Presents with dysphagia in adults and food bolus obstruction in up to 46% of cases 1
• Often has an insidious onset with patients developing coping strategies like drinking large volumes of water with meals 1
• Strong association with atopic conditions and allergies

2. Infectious Esophagitis

• Caused by fungal (Candida), viral (CMV, HSV), or bacterial agents 2
• More common in immunocompromised patients
• Can present with foreign body sensation along with odynophagia and dysphagia

3. Reflux Esophagitis

• Chronic acid exposure causing inflammation
• Can present with foreign body sensation, often described as "globus pharyngeus" 1

Distinguishing Features

It's important to differentiate between:

1. True foreign body impaction - Actual physical object lodged in the esophagus requiring removal 1
2. Foreign body sensation due to esophagitis - Perception without physical object
3. Globus pharyngeus - A functional disorder with sensation of a lump in the throat without dysphagia 1

Diagnostic Approach

When a patient presents with foreign body sensation:

1. Rule out actual foreign body impaction - Especially in patients with risk factors:

   • History of foreign body ingestion
   • Sudden onset of symptoms
   • Complete inability to swallow saliva (suggests true obstruction) 1

2. Consider esophagitis if:

   • Persistent sensation despite no visible foreign body
   • Associated symptoms like dysphagia, odynophagia
   • History of atopy or allergies (suggests EoE)
   • Immunocompromised state (suggests infectious esophagitis)

3. Endoscopy with biopsy is the gold standard for diagnosis of esophagitis 1

   • Allows visualization of mucosal changes
   • Enables histological confirmation of diagnosis
   • Can identify underlying structural abnormalities

Clinical Pearls and Pitfalls

Pearls:

• Foreign body sensation without an actual foreign body should prompt investigation for esophagitis, particularly EoE
• In adults with food bolus impaction, up to 46% may have underlying EoE 1
• Patients with persistent foreign body sensation should undergo endoscopic evaluation even if radiographic examination is negative 1

Pitfalls:

• Assuming globus sensation is always functional or psychological
• Missing underlying EoE in patients with recurrent foreign body sensation or impactions
• Failing to obtain esophageal biopsies during endoscopy in patients with foreign body sensation
• Overlooking that the absence of oral lesions does not rule out significant esophageal inflammation

In summary, esophagitis is an important cause of foreign body sensation in the throat or esophagus. Proper diagnosis through endoscopy and biopsy is essential for appropriate management and prevention of complications such as food impaction, strictures, and recurrent symptoms.