What are the treatments for the sensation of food getting stuck in the upper stomach?

Treatment for Sensation of Food Getting Stuck in Upper Stomach

Therapeutic flexible endoscopy is the recommended first-line treatment for persistent esophageal food impaction, with emergent endoscopy (within 2-6 hours) indicated for complete obstruction and urgent endoscopy (<24 hours) for partial obstruction. 1

Diagnostic Approach

When a patient presents with the sensation of food getting stuck in the upper stomach, it's important to determine whether this represents:

1. Esophageal dysphagia: Sensation of food stopping after swallowing

   • Most commonly caused by GERD, eosinophilic esophagitis, or functional disorders 2
   • May present as food impaction requiring intervention

2. Oropharyngeal dysphagia: Difficulty initiating swallowing with coughing/choking

   • Often associated with neurological conditions 3

Initial Evaluation

• Imaging: CT scan is recommended for suspected complications like perforation 1
• Avoid contrast studies: Barium or gastrografin studies should be avoided in complete obstruction due to aspiration risk 1
• Endoscopy: Upper GI endoscopy is the primary diagnostic tool for persistent symptoms 2

Treatment Algorithm

1. Acute Food Bolus Impaction

• Emergent flexible endoscopy (within 2-6 hours) for complete obstruction 1
• Urgent flexible endoscopy (<24 hours) for partial obstruction 1
• Endoscopic techniques:
  • Gentle pushing of food bolus into stomach (push technique) - 90% success rate 1
  • If unsuccessful, retrieval using baskets, snares, or grasping forceps 1
  • For impacted food in lower esophagus, balloon catheter can be used to disimpact the food bolus 1

2. Chronic or Recurrent Symptoms

• Diagnostic workup for underlying causes:

  • Esophageal stricture, hiatal hernia, Schatzki ring, eosinophilic esophagitis, achalasia, tumors 1
  • Biopsies to rule out eosinophilic esophagitis (found in up to 9% of patients) 1

• Acid suppression therapy:

  • First-line therapy with PPI (e.g., omeprazole 20mg once daily before breakfast) for 4-8 weeks 4
  • Adjunctive therapy with alginate antacids for breakthrough symptoms 4
  • H2-receptor antagonists (e.g., famotidine 20mg) for nocturnal symptoms 4

• Anti-gas medications:

  • Simethicone to reduce gas bubbles and provide relief from pressure and bloating 4

3. Management of Functional Causes

• Dietary modifications:

  • Supervised exclusion diet with a dietitian 4
  • Low-FODMAP diet under guidance if symptoms persist after 2-4 weeks 4
  • Reducing gas-producing foods and artificial sweeteners 4

• Behavioral therapies:

  • Diaphragmatic breathing exercises 1
  • Cognitive behavioral therapy for supragastric belching 1
  • Relaxation training (10 sessions over 8 weeks) 4

Special Considerations

Belching Disorders

• Supragastric belching: A behavioral disorder where air is sucked into the esophagus and immediately expelled 1

  • Often triggered by anxiety or stress
  • Stops during sleep, distraction, or when speaking 1
  • Best treated with behavioral strategies and diaphragmatic breathing 1

• Gastric belching: Physiological release of air from the stomach 1

  • May be associated with GERD
  • Often responds to acid suppression therapy

Medication-Related Causes

• Neuroleptic medications: Can cause dysphagia through multiple mechanisms 5
  • Extrapyramidal syndrome causing bradykinesia
  • Tardive dyskinesia affecting esophageal movements
  • Acute laryngeal or esophageal dystonia

Common Pitfalls to Avoid

1. Misattributing location: Obstructive symptoms that seem to originate in the throat may actually be caused by distal esophageal lesions 2

2. Overlooking eosinophilic esophagitis: Increasingly prevalent and requires esophageal biopsies for diagnosis 2

3. Delaying endoscopy: In cases of complete obstruction, emergent endoscopy (within 2-6 hours) is necessary to prevent complications like aspiration and perforation 1

4. Neglecting underlying causes: Always evaluate for potential underlying diseases including histological evaluation 1

5. Inappropriate use of contrast studies: Should be avoided in complete obstruction due to aspiration risk 1

By following this structured approach to evaluation and management, patients with the sensation of food getting stuck in the upper stomach can receive appropriate and timely care to prevent complications and address underlying causes.