Feeling Of A Sore Lumpy Area In Left Side Of Throat. Throat Is Dry And Having Esophagitis. Bitter Taste In Mouth. Suggest Medication?

Posted on Mon, 11 Nov 2013

Question: I have a feeling of a sore lumpy area in the bottom left side of my throat which has been there for close to a month.My throat gets very dry during the night and most often my sleep is intermittent due to that.Because of that i also get tired very easily after exercise.Initially it seemed to be helped with ppi's but now i take one ppi plus one xantac per day and do not see much progress.I am going thru a bad bout of esophagitis (last 3 months).Do you think this throat problem is just irritation from the acids coming back up?Can the ENT specialist scope this problem in their office or do we need that done in hospital.I am finding last few days that the bitter taste in the mouth is there almost all day and am afraid the next phase will be regurgitating...Do you have any advice and how long should i put up with this before considering the nissen fundoplication (my voice is quite hoarse).Thx.
XXXXXXX

Answered by Dr. Hariom Sharma (3 hours later)

Brief Answer:
First Conservative treatment

Detailed Answer:
Hi,

I have gone through your query.

Your symptoms seem to be related to GERD. I personally conservative treatment and strict life style modification in all cases of GERD first. If a 3 month trial of conservative treatment doesn't solve the problem significantly, then go for surgical plan-

You can control your disease by-
1. Avoiding foods such as chocolate, coffee, peppermint, greasy or spicy foods, tomato products, and alcoholic beverages.
2. Avoiding overeating.
3. Quitting smoking.
4. Lose weight if you are overweight.
5. Not eat 2 to 3 hours before sleep.
6. Wearing loose-fitting clothing around the stomach area.
7. Remaining upright for 3 hours after meals.
8. Raising the head of the bed 6 to 8 inches.

Beside PPI you may also add H2 receptor antagonists, Prokinetic agents and Antacids. If necessary you may also add antibiotics for the eradication of the H.Pylori. And yes, upper GI endoscopy done by a trained gastroenterologist can be helpful.

Hope this helps. If you have any doubt, I will be available to address them.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Hariom Sharma (31 hours later)

Thanks Doc.,

I have been doing the conservative plan for at least 3 months now.When the throat problem came up in July the situation appeared to get worse and i moved to 1 xantac and 1 ppi (from 1 ppi).Now i have to take gaviscon before going to bed on top of that and my throat and mouth feels bitter most of the day.

The gastroenterologist says the throat problem is not his but more a ENT specialist like you.Shouldn't it be diagnosed with a scope of some kind?Is it LPR?

I had a scope in spring 2012 which showed moderate espophagitis and some gastritis.I had a catscan last month and showed no major issues.

How long before the acid reflux causes permanent damage and maybe cancer?

Answered by Dr. Hariom Sharma (16 hours later)

Brief Answer:
24 hour pH monitoring

Detailed Answer:
Hi Sir,

If you have tried conservative treatment for more than 3 months without the expected results, then we can try
1. 24 hour pH monitoring
2. Reflux Symptom Index (RSI)
A RSI > 10 could indicate significant laryngopharyngeal reflux.

I hope these test help you to diagnose the symptoms better which in turn can help your doctor decide the right treatment.

If you are non smoker and non alcoholic then there is no need to worry about the laryngeal cancer.

Hope this helps. If you have any doubt, I will be available to answer them.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Hariom Sharma (22 hours later)

Thank you again doctor.I am a non-smoker and was a one drink per two days drinker (modest) but discontinued that for the gerd diet.I exercised regularly but now it's difficult due to abnormal fatigue after exercise.
I looked at the RSI rating on Google and it is subjective but my best estimate would be between 11 and 15 due to mainly hoarseness,throat clearing and excess mucus plus acid reflux and globus.
I am going for the esophagal mannometry and 24 hour ph test in 2 weeks.
It is difficult for me to XXXXXXX 100% of the gerd diet as i am lactose intolerant but i can do about 85%.
But it seems like all foods cause me some form of acid reflux especially in the evening.
Do you know of any other treatment but the nissen fundoplication (i know it doesn't come with a guarantee) to bring me back some quality of life?
It is good that i talked to you as my doctor didn't want to send me to our ent specialist because he would likely ask for the conservative treatment first which i already did.I was going to push but based on your comments the next step is the mannometry or are there any other potentially good solutions?

Thx. again in advance.

Note:i have been on ppi's for 15 years...the last two years they are not working very well.A simple small meal should not take so much of my energy for digestion.

Answered by Dr. Hariom Sharma (1 hour later)

Brief Answer:
Mannometry

Detailed Answer:
Hi,

At this point of time, I have no useful suggestions apart from manometry and 24 pH monitoring. You should get this test done before you plan surgery.

Besides the diet, I still encourage you to continue my first 8 lifestyle changes. It's going to help you even after you undergo surgery.

Hope you found this site helpful. Thanks again and Wish you good health

Regards

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad