I get excess mucus in throat while talking with chest burning. Why?

Question

Hello doctor,

For two weeks now, I have been clearing my upper throat of what seems like excess mucus. It happens every few minutes when talking but not when keeping quiet or sleeping. It almost feels like my upper esophagus fills with fluid when talking and then I have to clear it. There is sometimes a mild burning in the upper chest. I have GERD and am on 40 mg Nexium every day. This is not the same as normal reflux I would feel if I forgot to take my Nexium and this is a lot higher up. I have seen an ENT who looked at my throat and larynx and said all is normal. Should I be worried about this?

Answer 1

Hello,

Welcome to icliniq.com.

Well, I do not think that you should be worried due to this. As you rightly pointed out this is not similar to common reflux that would otherwise occur in GERD. It is actually acid, however, they might be normal esophageal secretions that occur in response to GERD (gastroesophageal reflux syndrome). Our esophagus (food pipe) have sub-mucosal (the lining beneath the superficial lining of esophagus) glands which produces viscous secretion, which smears the esophagus to make it moist and healthy.

In patients with GERD, this secretion is overly produced. Hence, you might be feeling that mucus in the upper part of the esophagus. Well, this maybe not the only explanation to your sensation of that mucus feeling in throat, there is one more thing called functional hypersensitivity. The nerves which carry signals of pain, touch, and temperature from the esophageal wall are hypersensitive. These nerves just pronounce everything they perceive and the person now feels those normal secretions, or acid, as somewhat more sensitive than previous. And do occur when a person is awake and in the day time.

Functional hypersensitivity can occur in anybody not necessarily among patients with GERD. But definitely it more commonly affects patients with GERD.

So how is it going to be treated.

1. Increase the dose of Nexium 40 gm to twice daily for a week and see if it help.

2. Try to understand this and avoid or try ignoring it. Or like take a sip of water.

3. If nothing helps really then I may consider starting you on low dose tricyclic antidepressants (TCA), this will control functional hypersensitivity.

I want to know how you feel starting your TCA. These are antidepressant but started on very low doses, not such much dosing which are given to treat depression. They frequently associated with side effects the common of which are dry mouth, dry eyes, constipation, and altered sleep. Let me know your side about this explanation and plan of action.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, you just relax, this is nothing serious. The risk of esophageal cancer is very very low like 0.1% of all GERD patients. The patient who have chronic uncontrollable symptoms of GERD like more than 10 years duration, they have risk of developing Barretts esopahgus which is a premaligant condition.

Out of such patients, only 1% develop esophageal cancer. So the risk is very low, it seemingly negligible among individuals with controlled GERD. Just quickly go through my article and you would have an idea what I am talking to.

I get excess mucus in throat while talking with chest burning. Why?

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