Normal tests but episodic inability to initiate swallow for 1 year — functional dysphagia or something missed?
For the last year I’ve been dealing with severe swallowing problems that nobody can fully explain. Diagnosed with GAD, depression, and functional dysphagia, but I still keep doubting it because of how physical and disabling this feels.
Main issue is not food getting stuck in the esophagus. The problem is initiating the swallow itself, especially later in the day. Mornings are usually my “safe window” where I can eat somewhat normally after waking up, but as the day progresses my swallowing ability gradually feels weaker and weaker until nighttime where it can become nearly impossible to swallow even saliva. Sleep is the only thing that partially resets it.
During bad episodes (lasting 1–4 days), I can almost completely lose the ability to swallow. I’ve survived on saline during the worst ones. I feel the urge to swallow but physically cannot trigger it. Sometimes I even make weird body movements trying to force the swallow reflex. It feels like choking on air. Pills are the hardest — I keep biting them because I can’t coordinate swallowing both pill and water together.
Important details:
- Food usually does NOT get stuck
- Never truly choked but feels like nearly choked sometimes
- Symptoms fluctuate massively
- Fear around swallowing developed over time, especially when alone
- Mucus/throat clearing sensation sometimes happens
- “Stuck in throat” feeling occurs mostly during worst days
Tests done:
- Endoscopy: normal
- Barium swallow: normal
- Esophageal manometry: normal
The strange part is during the barium swallow study I was able to swallow large mouthfuls of thick liquid on command completely normally, while at home I sometimes struggle with even saliva or tiny sips of water.
GI doctor now refuses further testing and says it’s completely functional. Currently on escitalopram + benzo for 3 weeks but no major improvement yet. Still losing weight because I can only reliably eat once in the morning.
Has anyone here experienced this kind of state-dependent swallowing problem where the ability seems to “shut down” as the day goes on and reset after sleep?