Ask a specialist: Lump in the throat

Question:

I have the feeling of a lump in my throat, no matter how much I cough or drink it does not clear. My voice can also be hoarse at times. Why is this happening?

Answer:

“One of the most common reasons people come to see a gastroenterologist is because they feel like they have a lump in their throat. It can feel worrying, but it rarely indicates that anything is seriously wrong.

“The medical term used to describe this is a ‘globus’ and there are several reasons why you may experience this.

“If you have the symptoms of a globus, you will normally be seen by both a gastroenterologist and an ear, nose and throat (ENT) specialist as there are broadly three possible causes. The first is an ENT problem, the second is it could be caused due to gastro-oesophageal reflux which is a gastro-intestinal issue, or in some cases, it can be caused by anxiety.

“Gastro-oesophageal reflux disease (GORD) occurs when acid from the stomach leaks up into the oesophagus (gullet), usually as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Along with irritable bowel syndrome (IBS), GORD is one of the most common reasons people visit a gastroenterologist, accounting for around 80 per cent of patient visits. The number of patients we’ve seen with GORD has increased in recent years and it is now one of the most common causes of indigestion we see at LivingCare.

“GORD can have a large variety of symptoms, and two of the most common are heartburn and acid reflux. Other symptoms include: chest pain, nausea (especially first thing in the morning), persistent dry cough and difficulty swallowing food.

“It is very important to distinguish globus from true difficulty swallowing, which is called dysphagia. This means food goes down slowly and/or gets stuck, often indicating a problem in the lower gullet such as inflammation, or in some cases, oesophageal cancer.

“Dysphagia is a serious condition and indicates the need for urgent referral to a gastroenterologist for investigation. This often involves an endoscopy, but we will talk you through treatment once you have been assessed. In most cases globus is not associated with true dysphagia and we will take a careful medical history in order to assess the next steps for you.

“If you have globus, we also take a similar approach, getting a detailed medical history then explain the possible causes and usually perform an endoscopy. The endoscopy enables serious pathology to be excluded in the vast majority of patients and will highlight any complications of GORD, such as inflammation of the gullet or a benign stricture, both of which can be caused by acid. If we think you have GORD, based on your symptoms and/or confirmed by endoscopy, we will start treatment to suppress acid. This will often get rid of the globus.

“In instances where your endoscopy is normal and GORD isn’t suspected, you may be referred on to one of our ear, nose and throat specialist, if you haven’t already seen one. This careful approach often means the symptom of globus can be relieved, and more importantly you have peace of mind.”

Dr Mark Denyer, consultant gastroenterologist at LivingCare, MB BS, FRCP

At LivingCare we provide all of our services for NHS patients as well as on a private basis. To be seen through the NHS for any of our services, we just require a referral from your GP. Alternatively, you can be seen privately.

If you would like to find out more information about our services, or book an appointment, please call 0113 249 4655 and a member of our team will be happy to help you.