I am recovering from bulimia and fear that I may have permanently damaged my throat. It feels tight, like there is something stuck in there. I am also under a lot of stress at this time and am wondering if it might just be nerves. What do you think?

H.P.

To prevent weight gain, patients with bulimia frequently make themselves vomit after ingesting large amounts of calories during a food binge. Such recurrent vomiting can lead to tears in the lining of the lower esophagus. These tears can cause severe pain and significant bleeding. Although this complication is severe, sometimes requiring endoscopy to stop the bleeding, the tears will usually heal.

Another common complication of recurrent vomiting is irritation and inflammation of the lining of the esophagus, known as esophagitis. This occurs because the esophagus is constantly exposed to the stomach's contents, which contain acid and other injurious substances. This is similar to the situation seen in patients with gastroesophageal reflux disease (GERD), except that the injury with frequent vomiting is potentially much more severe. The esophageal damage may include erosions and ulcers, which can often easily be seen using an endoscope (a viewing device placed down the throat). When these ulcers heal -- typically, when the patient stops the cycle of vomiting -- scarring can occur in the esophagus. This scarring can result in strictures, narrowings of the esophagus that may lead to difficulty in swallowing food or a feeling that food is stuck in the esophagus. Strictures may be treated by procedures to stretch or dilate the narrowed areas.

Patients with bulimia also commonly have very high levels of stress and anxiety in their lives. It is known that these can create symptoms of tightness in the throat, similar to what a patient with a stricture might have. It is impossible for me to tell whether your symptoms are related to a stricture or are entirely anxiety-induced. You should report your symptoms to a doctor and obtain a referral to a gastroenterologist. This specialist can make the correct diagnosis after an endoscopic exam, and can give the appropriate treatment.