What type of dysphagia is characterized by the sensation of food feeling stuck in the throat?

The Sensation of Food Feeling Stuck in the Throat is Characteristic of Oropharyngeal Dysphagia

The sensation of food feeling stuck in the throat is primarily characteristic of oropharyngeal dysphagia, though it can also be a referred symptom from esophageal dysphagia or globus pharyngeus. 1

Types of Dysphagia and Their Distinguishing Features

Oropharyngeal Dysphagia

• Patients typically complain of food sticking in the throat or a globus sensation (feeling of a lump in the throat) 1
• Associated symptoms include:
  • Coughing or choking during swallowing (due to laryngeal penetration or aspiration)
  • Nasal-quality voice or nasal regurgitation (due to soft palate insufficiency)
  • Food dribbling from the mouth
  • Difficulty initiating swallow or chewing 1
• Occurs due to dysfunction in the voluntary muscles of the oropharynx 1
• Positive diagnostic signs include inability to swallow despite absence of drooling or excessive oral secretions 1

Esophageal Dysphagia

• Characterized by difficulty swallowing several seconds after initiating a swallow 2
• Sensation of food getting stuck in the esophagus rather than the throat 2
• Patients may report retrosternal pain, heartburn, regurgitation, or vomiting 3

Globus Pharyngeus (Important Differential)

• Presents as a recurrent, non-painful but uncomfortable sensation of a lump in the throat 1
• Occurs in the absence of true dysphagia, odynophagia, or GERD 1
• More obvious between meals and typically improves with eating 1
• Often associated with throat clearing, sense of mucus build-up, dry throat, repeated swallowing 1
• Must be distinguished from true dysphagia, though empirical data suggests 20% of patients with functional dysphagia experience globus sensation with swallowing 1

Diagnostic Considerations

Important Clinical Caveat

• Abnormalities of the mid or distal esophagus or even the gastric cardia may cause referred dysphagia to the upper chest or pharynx 1
• This means that patients reporting food stuck in the throat may actually have a distal esophageal issue 4
• In a study of patients complaining of "food sticking in the throat," 71% had explanatory causes identified in the esophagus rather than the pharynx 5

Diagnostic Approach

1. Determine if dysphagia is oropharyngeal or esophageal based on symptom presentation 2
2. Evaluate for both structural and functional abnormalities 6
3. Consider complete examination of the esophagus even when pharyngeal symptoms are reported, as 68% of patients with dysphagia for solids have abnormal esophageal transit 1

Diagnostic Testing

• Modified barium swallow to evaluate oral and pharyngeal phases of swallowing 6
• Videofluoroscopy to assess bolus manipulation, tongue motion, hyoid and laryngeal elevation 6
• Esophagogastroduodenoscopy recommended for initial evaluation of esophageal dysphagia 4
• Barium esophagram as an adjunct, particularly biphasic studies which are preferable to single-contrast for mucosal detail 1
• Non-masticated marshmallow during testing has shown the highest diagnostic yield (71%) in identifying explanatory causes 5

Clinical Implications

The sensation of food sticking in the throat requires thorough evaluation due to potential serious consequences:

• Risk of aspiration pneumonia, particularly in neurologically impaired patients 6
• Potential for malnutrition and weight loss 1
• Significant impact on quality of life comparable to dysphagia associated with head and neck cancer 1

Accurate diagnosis is essential as patients often have poor localization of symptoms, with only 18% accuracy when the cause is physiologic versus 75% accuracy when the cause is anatomic 5.