Dysphagia and Chest Pain in Adolescent with GERD History

Case at a Glance

A 16-year-old female presenting with progressive dysphagia, sensation of food impaction, and chest pain in the setting of known gastroesophageal reflux disease (GERD).

Patient's Story

The patient reported a one-year history of acid reflux symptoms that had recently worsened. She described a distressing sensation of food becoming stuck in her throat and chest area, with the feeling that swallowed food would descend partially before returning upward. This was accompanied by significant chest and epigastric pain. The patient weighed 55kg and appeared distressed by her symptoms, which were affecting her quality of life and eating habits.

Initial Assessment

Physical examination revealed a thin adolescent female in mild distress. Vital signs were stable. Abdominal examination showed mild epigastric tenderness. No palpable masses or lymphadenopathy were detected in the neck region. The patient's weight of 55kg raised concerns about potential nutritional impact from her swallowing difficulties.

The Diagnostic Journey

Given the patient's symptoms of dysphagia with the sensation of food regurgitation, combined with her history of GERD, differential diagnoses included esophageal stricture, achalasia, eosinophilic esophagitis, or functional dysphagia. The chronicity and progressive nature of symptoms warranted further investigation with upper endoscopy and possibly esophageal manometry.

Final Diagnosis

Globus sensation (globus pharyngeus) secondary to gastroesophageal reflux disease, with possible functional dysphagia component.

Treatment Plan

Management focused on aggressive acid suppression with proton pump inhibitors, dietary modifications including smaller frequent meals and avoiding trigger foods, elevation of the head of bed, and stress management techniques. Referral to gastroenterology for further evaluation and possible endoscopic assessment was recommended.

Outcome and Follow-up

Patient education regarding globus sensation helped alleviate anxiety about the symptoms. The condition was explained as uncomfortable but not dangerous, often associated with stress and acid reflux. Follow-up appointments were scheduled to monitor symptom progression and treatment response, with the understanding that symptoms often improve with time and appropriate GERD management.