title: Lump in the throat.
abstract: The symptoms of repeatedly swallowing what the patient believes is a postnasal discharge, lump in the throat, and constantly having to clear the throat are commonly encountered in patients who do not show any evidence of sinusitis or organic lesions in the upper gastro-intestinal tract or larynx. It is suggested that incompetence of the lower oesophageal sphincter could lead to the creation of this situation by lowering the pH in the oesophagus and initiating inco-ordinate peristaltic movement. A trial of treatment of 54 patients, selected on a nonrandomized consecutive basis and presenting with the above symptoms, was undertaken, treatment being aimed at increasing the cholinergic activity of the oesophageal smooth muscle and neutralizing acidity. Metoclopramide (Maxolon, Primperan) was the cholinergic agent and polymethylsiloxane aluminium hydroxide (Asilone) was the antacid selected. Results based on symptomatic improvement showed that of 44 patients who reported for the follow-up examination, 35 (83%) had good symptomatic improvement, and 7 (16%) were unchanged. The action of metoclopramide is discussed and some of the literature reviewed. Favourable symptomatic improvement suggests that further trials using this substance, together with a placebo, on a cross-over randomized basis would be worth while. The 'lump in the throat' syndrome can be recognized by the symptom tetrad of: (i) lump in the throat; (ii) repetitive swallowing; (iii) clearing of the throat; and (iv) indigestion.
mesh_terms: D000328:Adult; D000536:Aluminum Hydroxide / Q000627:therapeutic use; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D010608:Pharyngeal Diseases / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000536:Aluminum Hydroxide; D008787:Metoclopramide