What could be causing my feeling of fullness and sensation of something stuck in my throat after eating, without any history of heartburn or throat irritation?

Understanding Your Throat and Fullness Symptoms

Most Likely Diagnosis

Your symptoms of post-meal fullness and throat sensation without heartburn most likely represent either globus sensation (a functional throat disorder) or gastroesophageal reflux disease (GERD) presenting atypically, though esophageal dysphagia from a structural or motility problem must also be excluded. 1, 2

Key Distinguishing Features

Globus Sensation vs. True Dysphagia

The critical distinction is whether eating makes your throat sensation better or worse:

• Globus sensation typically improves during eating and is more noticeable between meals, presenting as a non-painful lump feeling in the throat 1
• True dysphagia worsens with swallowing food, with patients experiencing actual difficulty or obstruction when food passes 1, 3
• Your description of "something stuck in throat" after eating suggests this may be true dysphagia rather than globus, which would improve with food intake 1

Post-Meal Fullness (Early Satiety)

The sensation of feeling full quickly after eating can indicate:

• Esophageal or gastric outlet obstruction requiring structural evaluation 4
• Esophageal motility disorders affecting food transit 5
• Gastroesophageal reflux causing referred sensations to the throat 2, 6

Critical Warning Signs Requiring Urgent Evaluation

You need immediate endoscopy if you have:

• Inability to swallow saliva (complete obstruction) 4
• Progressive worsening of swallowing difficulty 4
• Weight loss 4
• Pain with swallowing (odynophagia) 4

Recommended Diagnostic Approach

First-Line Investigation

You should undergo upper endoscopy (after stopping any acid-suppressing medications for at least 2 weeks) to rule out structural causes including strictures, tumors, or inflammation. 4

If Endoscopy is Normal

A combined fluoroscopic examination (biphasic esophagram with video fluoroscopy) of the pharynx, esophagus, and gastric cardia is the most appropriate next step for unexplained throat and swallowing symptoms. 4

This combined approach is superior to either test alone because:

• Abnormalities in the distal esophagus or gastric cardia can cause referred sensations to the throat, even though the problem originates lower down 4
• In one study, 68% of patients with dysphagia complaints had abnormal esophageal transit, and in one-third of these, the esophageal abnormality was the only finding 4
• Video fluoroscopy assesses swallowing function dynamically 4
• Static imaging evaluates for structural lesions 4

Additional Testing if Initial Studies Are Negative

Esophageal manometry with pH/impedance monitoring should be performed if imaging is unrevealing, as this can detect:

• Esophageal motility disorders (ineffective esophageal motility is the most common abnormality in patients with globus-like symptoms who don't respond to acid suppression) 5
• Gastroesophageal reflux (which can cause throat symptoms in 20-60% of GERD patients without typical heartburn) 2

Initial Management Strategy

Empirical Acid Suppression Trial

Despite your lack of heartburn, a high-dose proton pump inhibitor (PPI) trial for 8 weeks is reasonable as first-line therapy because:

• GERD can present with throat symptoms alone in 20-60% of cases without heartburn 2
• Gastroesophageal reflux with esophagitis must be excluded, especially in patients with globus sensation 3
• This is considered standard empirical therapy after excluding organic disease 5

Lifestyle Modifications

Implement these changes immediately while awaiting evaluation:

• Avoid large meal volumes and eat smaller, more frequent meals 7
• Don't eat within 3 hours of bedtime 7
• Avoid fatty, fried, spicy foods, chocolate, coffee, carbonated beverages, and alcohol as these trigger GERD symptoms 7
• Maintain upright posture after eating 7

Common Pitfalls to Avoid

Do not assume this is "just stress" or functional globus without proper evaluation, as:

• True structural problems (strictures, tumors, webs) can present similarly 4
• Esophageal motility disorders require specific treatment 5
• Mistaking true dysphagia for globus leads to inappropriate treatment 1

Do not undergo barium swallow as your first test - it should not delay endoscopy and can coat the mucosa, impairing visualization if endoscopy is subsequently needed 4

If PPI Trial Fails

If symptoms persist after 8 weeks of high-dose PPI therapy:

• Proceed with esophageal manometry and pH/impedance monitoring 5
• Consider adding prokinetic agents if motility disorder is identified 5
• Evaluate for psychological factors only after excluding all organic and motility causes 5