What could be causing my foreign body sensation in the throat and continuous burping?

Foreign Body Sensation in Throat with Continuous Burping

Your symptoms most likely represent gastroesophageal reflux disease (GERD) causing globus pharyngeus, though actual esophageal foreign body impaction must be ruled out first, especially if you have acute dysphagia or inability to swallow saliva. 1

Immediate Assessment Required

If you cannot swallow saliva or are vomiting, you need emergent endoscopy within 2-6 hours as this indicates complete esophageal obstruction. 1, 2 The combination of foreign body sensation and burping suggests reflux, but up to 68% of patients with pharyngeal complaints actually have esophageal pathology that can refer symptoms to the throat. 1

Critical Red Flags Requiring Emergency Evaluation:

• Inability to swallow saliva - requires emergent endoscopy within 2-6 hours 1, 2
• Acute onset dysphagia with vomiting - suggests foreign body at hypopharynx or upper esophagus 1
• Fever, neck tenderness, or subcutaneous emphysema - indicates possible perforation requiring immediate surgical consultation 1

Most Likely Diagnosis: Globus Pharyngeus

Globus pharyngeus is a functional disorder presenting as a recurrent, non-painful sensation of a lump in the throat, commonly associated with GERD and often accompanied by throat clearing and burping. 3 This condition:

• Presents as sensation of foreign body, tightening, or choking feeling in throat 3
• Improves with eating but is more obvious between meals - a key distinguishing feature 3
• Often associated with throat clearing, sense of mucus buildup, and chronic cough 3
• Commonly co-occurs with psychological stress and exacerbates during high emotional intensity 3
• Must be distinguished from true dysphagia, though 20% of patients with functional dysphagia also experience globus 3

Diagnostic Approach

Initial Evaluation:

Avoid routine radiographs - they have limited utility with false-negative rates up to 85% for food bolus and are inappropriate for routine assessment of foreign body sensation. 2, 4 Instead:

• Thorough clinical examination of hypopharynx and neck has high diagnostic yield 4, 5
• Flexible fiberoptic laryngoscopy should be performed if symptoms persist, as it identifies pathology in the majority of cases 4, 5
• CT scan is mandatory only if clinical suspicion for actual foreign body remains high after negative examination, with 90-100% sensitivity 1, 2

Important Diagnostic Pitfall:

Abnormalities of the mid or distal esophagus can cause referred dysphagia to the pharynx and upper chest, so the entire esophagus must be evaluated even when symptoms seem pharyngeal. 1 One-third of patients have esophageal pathology as the only finding. 1

When Endoscopy Is Indicated

If you have true dysphagia (difficulty swallowing) rather than just globus sensation, endoscopy is warranted to evaluate for:

• Eosinophilic esophagitis - found in up to 46% of patients with food impaction 2
• Esophageal stricture, rings, or webs 2
• Hiatus hernia or achalasia 2

During endoscopy, at least 6 biopsies from different esophageal sites should be obtained to evaluate underlying pathology. 2

Management Strategy

For Globus Pharyngeus (Most Likely):

• Trial of proton pump inhibitor therapy for presumed GERD-related symptoms 3
• Antidepressants may be beneficial based on evidence in overlapping disorders causing esophageal discomfort 3
• Avoid unnecessary pharmacologic interventions like fizzy drinks, baclofen, or benzodiazepines which lack clear evidence 2

If Actual Foreign Body Found:

• Emergent flexible endoscopy within 2-6 hours for complete obstruction 1, 2
• First attempt gentle pushing into stomach (90% success rate), then retrieval if pushing fails 2
• Delay beyond 24 hours significantly increases perforation risk 1

Uncommon but Important Consideration

Displaced superior cornu of the thyroid cartilage can cause persistent foreign body sensation at the hyoid level and is surgically correctable. 6, 5 This diagnosis requires:

• Careful laryngoscopic examination by an otolaryngologist 5
• Can be overlooked and misdiagnosed as chronic pharyngitis or reflux 5
• Surgery successfully eliminates symptoms when identified 6

Follow-Up Required

If symptoms persist despite treatment, arrange outpatient endoscopy to confirm the cause and institute appropriate therapy for any underlying condition. 2 If endoscopy reveals no foreign body but symptoms continue, biphasic barium esophagram should be performed to evaluate for subtle rings, strictures, or motility disorders (96% sensitivity). 1