Feeling of Something Stuck in Throat After Eating
The sensation of food sticking in the throat after eating most commonly indicates esophageal dysphagia, which is typically caused by gastroesophageal reflux disease (GERD), eosinophilic esophagitis, or structural abnormalities—and requires esophagogastroduodenoscopy (EGD) with biopsies as the initial diagnostic test. 1
Understanding the Symptom Location vs. Actual Pathology
A critical pitfall: where you feel the obstruction is NOT where the problem actually is. Patients who perceive food sticking in the throat or neck often have distal esophageal lesions causing referred sensations. 2, 1 Abnormalities of the mid or distal esophagus or even the gastric cardia commonly cause referred dysphagia to the upper chest or pharynx, whereas true pharyngeal abnormalities rarely cause referred symptoms. 2
Distinguishing Oropharyngeal vs. Esophageal Dysphagia
Esophageal Dysphagia (Most Likely in Your Case)
- Sensation of food getting stuck AFTER swallowing has been initiated 1, 3
- Food feels stuck in the chest or lower throat region 3
- No coughing, choking, or nasal regurgitation 2
- Most commonly caused by GERD, eosinophilic esophagitis, strictures, or functional disorders 1
Oropharyngeal Dysphagia (Less Likely Without Other Symptoms)
- Difficulty INITIATING the swallow 1
- Coughing or choking during swallowing 2
- Nasal regurgitation, wet/gurgly voice after swallowing 2
- Food dribbling from mouth 2
- Associated with neurologic conditions (stroke, Parkinson's, dementia) 2, 1
Most Common Underlying Causes
Eosinophilic Esophagitis (Increasingly Prevalent)
- Found in up to 46% of patients presenting with food bolus obstruction 4
- Triggered by food allergens 1
- Requires esophageal biopsies (at least 6 from different sites) for diagnosis 4
- Often missed if biopsies not obtained during initial endoscopy 4
GERD and Reflux-Related Pathology
- Most common cause of esophageal dysphagia overall 1
- Can cause strictures, rings (Schatzki ring), or inflammation 4, 1
- May present with globus sensation (lump in throat feeling) 5
Structural Abnormalities
- Esophageal strictures (prevalence 11-31% in dysphagia patients) 2
- Esophageal rings or webs 4
- Hiatus hernia 4
Other Considerations
- Achalasia and esophageal motility disorders (relatively rare, may be overdiagnosed) 1, 3
- Opioid-induced esophageal dysfunction (increasingly common) 1
- Esophageal malignancy (low prevalence but must be excluded) 1
Recommended Diagnostic Approach
Initial Evaluation
Esophagogastroduodenoscopy (EGD) with biopsies is the recommended initial test for esophageal dysphagia. 1 During endoscopy, obtain at least 6 biopsies from different anatomical sites in the esophagus to evaluate for eosinophilic esophagitis and other mucosal pathology. 4
Alternative: Trial of Acid Suppression
In low-risk patients without alarm features (weight loss, progressive symptoms, age >50 with new onset), a 4-week trial of acid-suppressing therapy may be undertaken before endoscopy. 1 However, if symptoms persist, proceed directly to EGD with biopsies.
When to Consider Barium Studies
- Combined videofluoroscopic swallow study with barium esophagram is appropriate when both oropharyngeal and esophageal dysphagia are suspected 2
- Barium esophagram can serve as an adjunct to EGD for evaluating structural abnormalities 1
- For unexplained pharyngeal symptoms, evaluate the entire esophagus and gastric cardia since distal lesions cause referred sensations 2
Critical Pitfalls to Avoid
Don't Rely on Symptom Location Alone
The perceived location of obstruction is unreliable—always evaluate the entire esophagus even when symptoms seem localized to the throat. 2
Don't Skip Biopsies
Failure to obtain diagnostic biopsies during the index endoscopy leads to missed diagnoses, particularly eosinophilic esophagitis. 4 If adequate biopsies were not obtained, arrange elective repeat endoscopy. 4
Don't Use Contrast Studies for Acute Food Impaction
Contrast swallow studies are NOT recommended for acute food impaction as they increase aspiration risk and impair subsequent endoscopic visualization. 4
Recognize When It's Actually Oropharyngeal
If the patient has coughing/choking during swallowing, wet voice after swallowing, or known neurologic conditions, refer to a speech-language pathologist for oropharyngeal swallow evaluation before or concurrent with esophageal workup. 2
When to Seek Urgent Evaluation
Complete Obstruction/Food Impaction
- Emergent flexible endoscopy (within 2-6 hours) for complete esophageal obstruction due to aspiration and perforation risk 4
- Urgent endoscopy (within 24 hours) for incomplete obstruction 4
- Pharmacologic interventions (glucagon, nitroglycerin) have limited evidence and should not delay endoscopy 4, 6
Alarm Features Requiring Prompt EGD
- Progressive dysphagia 1
- Unintentional weight loss 2, 1
- Odynophagia (painful swallowing) 3
- Age >50 with new-onset symptoms 1
Follow-Up Considerations
After diagnosis of the underlying cause, appropriate therapy should be instituted. For eosinophilic esophagitis, withhold PPI for at least 3 weeks before repeat endoscopy if symptoms persist. 4 Outpatient review should confirm the diagnosis, educate the patient, and ensure appropriate long-term management. 4