OpenHealth Q&A

Navigating Dysphagia and Unexplained Symptoms

Let me share my story for some context: I’m a 21-year-old man who has generally maintained good health. However, in 2023, I suffered an untreated staphylococcus aureus infection in my sinuses that lingered for most of the year; the symptoms diminished during the summer, allowing me to largely forget about it. Fast forward to 2024, as I prepared for my exams, I pulled several all-nighters, battled cold weather, and dealt with poor posture. This culminated in a pain in my lower left rib area, followed by a persistent cough that produced pink-tinged sputum, accompanied by night sweats and chills. We visited the hospital where tests revealed a significant infection, but no immediate cause for alarm. An X-ray pointed to something concerning, so further imaging via CT was suggested. Although it stressed me out, I complied and underwent two CT scans—one with contrast. The radiologists detected a small mass near my pleura close to the right shoulder blade. Initially believed to be a lipoma, I was then referred to a specialized facility for further evaluation. They suspected tuberculosis, but subsequent testing eliminated that diagnosis. After spending ten days in the hospital and having been prescribed numerous antibiotics, a bronchoscopy was performed. When follow-up imaging showed the mass had shrunk, the biopsy was called off. Ultimately, the bronchoscopy identified an isolated pathogen known as "Burkholderia cepacia." Another twenty days of antibiotic treatment left me feeling much better, though I still experienced discomfort in my lower ribs. The doctors attributed this pain to my posture, which resonated with me, considering it intensified when I sat for long periods. The latest ultrasounds indicated the disappearance of the mass, leaving only a faint irregularity behind that was not detectable on X-rays. Now, I’d like to address my current health issues. Prior to these medical challenges, I dealt with nighttime reflux, occasionally resulting in aspiration; I recall a particularly bad incident a month before my health deteriorated. This is suspected to have instigated my subsequent infection. However, a troubling coincidence arose: two months post-hospitalization, I developed dysphagia (difficulty swallowing). Specifically, my symptoms included food feeling lodged at the base of my chest, a slow descent during swallowing, diminished capacity to burp, and sporadic sharp chest pains relieved only by drinking water. When food got stuck and I forced out a burp, it was often accompanied by foamy saliva. Growing increasingly concerned, I decided to seek medical attention on July 10. An upper endoscopy and barium swallow study ensued, revealing GERD, gastritis, and duodenitis. My treatment plan included PPIs, and I felt a sense of relief at finally addressing the issues. Although my symptoms fluctuated, they remained manageable. By late February 2025, I noticed a decline in my condition. Episodes of food getting stuck were more frequent, but the chest pains had lessened. Then in March, I started experiencing new sensations. A persistent feeling of something caught in the uppermost part of my throat emerged, and every time I swallowed while lying on my back, I detected a gurgling sound in my esophagus that ceased when I shifted to my side. Additionally, I started waking up at night, shivering with pale extremities, followed by an urgent need to use the bathroom, all without any fever. I once again sought out medical advice, leading to another gastroscopy that yielded no significant findings—merely gastritis and a “slightly spastic” lower esophageal sphincter, which the doctor suggested was contributing to my discomfort. Post-appointment, my nighttime shivers subtly diminished, although I would still awaken a bit chilly despite my warm room and blankets. Today, however, I suffered a notable recurrence of those chills, accompanied by pale hands and a pressing need to defecate, yet no fever presented. My online research indicated it might be a vasovagal response, reminiscent of experiences I’ve had during nosebleeds. This leads me to seek guidance: what steps should I take next? I’m concerned that a doctor might dismiss my worries as merely GERD-related and prescribe a higher dose of PPIs, as previously occurred before I insisted on a gastroscopy. What actions should I pursue now? What could potentially be causing these symptoms? Is this situation of concern? The persistent dread I feel about the possibility of something outside my esophagus compressing it and my vagus nerve is overwhelming, and the dysphagia is significantly impacting my appetite.

Answers (1)

3/26/2025, 11:31:12 AM

OpenHealth AI

I understand that you're going through a complex and distressing health journey, particularly with your dysphagia and its physical and emotional impacts. Your concerns about potential underlying causes are legitimate, especially following your history with infections and current symptoms. Let’s break down your situation in a structured way to help you navigate your next steps.

Main Points:

1. You have a history of significant infections and recent digestive issues, including dysphagia and GERD.
2. Your symptoms of dysphagia, nocturnal chills, and the urgency to defecate are concerning, especially as they fluctuate.
3. It’s essential to maintain open communication with your healthcare providers and to document your symptoms effectively.

Explanation:

Dysphagia (difficulty swallowing) can result from various causes, including reflux diseases, esophageal stricture, or spasticity of the esophagus, which you've been experiencing. The fact that you have discomfort when lying flat and that certain postures seem to cause symptoms may indicate a positional aspect to your condition. Additionally, the nocturnal chills and urgency suggest a possible autonomic response, which can sometimes be linked to anxiety or other physiological responses, but could also require further investigation.

Next Steps:

1. Maintain a Symptom Diary: Document the specifics of your symptoms, such as frequency, duration, associated activities (like posture or eating), and any triggers. This will provide valuable information to your healthcare provider and help you identify patterns.

2. Review Your Gastrointestinal Management Plan: Since your endoscopy indicated elevated issues, it may be helpful to discuss your current management plan with your healthcare team. Ask if adjusting your PPIs or including other medications (like prokinetics) could support your esophageal motility.

3. Consider Alternative Therapies: If your symptoms remain persistent, it could be worthwhile to investigate dietary changes, such as:

   • Eating smaller, more frequent meals to reduce esophageal stress.
   • Avoiding known triggers (spicy foods, caffeine, alcohol, etc.) that could exacerbate reflux.
   • Incorporating foods that may help soothe the esophagus, such as bananas, oatmeal, and yogurt.

4. Physical Adjustments: Improving posture can significantly impact how your esophagus works. Try using tools like a supportive chair or ergonomic adjustments during meals, and consider elevating your head while sleeping to aid in reflux management.

5. Schedule a Follow-Up: Given your complex history, if the symptoms worsen or do not improve with these strategies, schedule a follow-up with a gastroenterologist. Discuss your entire symptom history, emphasizing the recent changes and experiences, as well as the potential for functional esophageal disorders.

6. Explore Support: Emotional and psychological aspects can also affect physical symptoms, especially if anxiety around these health issues is high. Seeking support from a therapist, particularly one with experience in chronic illness, may provide you with coping mechanisms.

Conclusion:

Your health history necessitates careful monitoring and potentially further investigation to ensure that no underlying issues are overlooked. By keeping track of your symptoms and communicating effectively with your healthcare providers, you can advocate for yourself and undergo necessary evaluations or treatments. Remember, you are not alone in this, and it’s okay to seek clarification from your doctors whenever you feel uncertain. Let me know if you need more specific guidance or information about any of these steps.