Marshmallows for swallowing assessments!
Reviewed by Roganie Govender

The complaint of ‘food sticking in my throat’ is one many of us will have heard several times in clinical practice. The authors of this study report the prevalence of this symptom to be between 5-8% in the general population over 50 years of age. They suggest that very little research has been done to determine how accurately patients are able to identify the location of the problem, the characteristics they describe or how best to assess this symptom. They undertook a retrospective analysis of 141 videofluoroscopic swallow studies that were performed on patients reporting this symptom. All were carried out at a single institution following a similar protocol. They found that in 76% of patients (107/141) an explanatory cause was found on videofluoroscopy. This was defined as a clear restriction (stop of bolus flow) of the swallowed material. Of the patients with a clear identified cause, only 5% did not sense the food sticking when it occurred. Only one fifth of patients (20% of 141) who complained of food sticking in the throat actually had an explanatory cause localised to the pharynx or upper oesophageal sphincter. The restriction was most often demonstrated in the oesophagus. The explanatory cause was classified as ‘physiologic’ in 85% of cases and ‘anatomic’ in 15%. Cricopharyngeal bar was the most frequent non-obstructive abnormality. A non-masticated marshmallow was the best swallow material to identify this problem, which is often undetected if only fluids (barium alone) are used during the assessment. The take-away message seems to be that a significant proportion of patients who report this symptom, are likely to demonstrate an explanatory cause. This may only be observed if the correct swallow material is used, and if the assessment includes the full length of the oesophagus.

‘Food sticking in my throat’: videofluoroscopic evaluation of a common symptom.
Madhavan A, Carnaby GD, Crary MA.
DYSPHAGIA
2015;30:343-8.