A Teen Who Can't Swallow: Case Challenge

Matthew J. Greenhawt, MD, MBA


November 29, 2011

The Teen Who Can't Swallow

The Case

Chief complaint. Molly is a 14-year-old teen who presents to your office with a 9-month complaint of that certain foods "get stuck" in her throat. The sensation is intermittent, occurring about once a week, and more frequently when she eats meat, poultry, and crackers. She reports it is lessened by overchewing her food and by drinking water with each bite. Earlier this month, a friend performed the Heimlich maneuver to dislodge an item which "felt stuck in her throat." She has steadily increased the numbers of foods that she avoids, even those which she used to regularly enjoy because they take a lot of effort to swallow at times. Her parents have noted she will drink more than 4 cups of water with each meal, and takes a long time to chew and swallow. However, she does not complain of any pain when swallowing.

Additionally, she reports becoming more full with less and less amounts of food, and often coughs right after eating. However, her weight and activity level are unaffected. On questioning, she describes at least a 2-year history of intermittent epigastric and mid-sternal burning that is occasionally relieved with over-the-counter remedies such as omeprazole.

Medical history. She has well-controlled asthma and allergic rhinitis that were first noted several years previously. Her mother reports that as a very young child, Molly had a milk allergy but she "outgrew" that by about 6 years of age. She has no other allergic diseases.

Review of systems. Review of systems is positive for frequent nausea, occasional vomiting several hours after eating (less than 5 episodes a month, which improves when she takes omeprazole), and abdominal pain that will wake her from her sleep once or twice a month.

Family history. Her father suffers from gastroesophageal reflux disease (GERD) and some similar swallowing difficulties.

Physical examination. Her physical exam is unremarkable. Her parents are concerned that she may have irritable bowel syndrome or celiac disease after researching their daughter's symptoms on the Internet. They seek your advice.


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