Gastro Case Challenge: A 33-Year-Old Man Who Can’t Swallow His Own Saliva

Juan Carlos Munoz, MD; Carmela Monteiro, MD; Ivan E. Rascon-Aguilar, MD


September 06, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 33-year-old man presents to the emergency department 2 hours after eating lunch describing food stuck in his esophagus. He is unable to swallow his own saliva, which he has been spitting up since the onset of his symptoms. He states that he has had problems with swallowing solid food since childhood, but no significant episodes have required him to seek medical evaluation.

For the past few months, the patient has been experiencing worsening dysphagia. The symptoms seem to be intermittent, and they are rectified by chewing carefully and drinking water after swallowing solids. He does report a remote history of esophageal reflux unresponsive to esomeprazole.

His past medical history is otherwise remarkable only for sinusitis and allergies, for which he is currently taking antihistamines. The patient does not have any chest pain, shortness of breath, a history of oral thrush, odynophagia, smoking, heavy alcohol use, or any illicit drug use. He does not have any weakness, numbness, diplopia, or other visual changes.


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