Medical Mystery: What caused woman's terrible swallowing problems?

Jill Sherrill stepped on the scale at her gym and blanched. Her weight had slipped, again. In the previous 10 months, Sherrill, who is 5-foot-5, had lost 22 pounds without trying.

Her friends had urged her to consult her doctor about worsening digestive problems, but for a variety of reasons Sherrill had opted to treat herself.

But on that day in August 2015, the reading — 112 pounds — "scared me to death. I thought, 'Oh, my God, I'm dying,' " recalled the Sacramento, Calif., woman, who is now 72.

Other health problems had been plaguing her for a while. In 2014, she had complained to her dentist of a swallowing problem and occasional episodes in which she coughed up food. He told her he'd never heard of such a problem.

A year later, Sherrill saw her longtime family physician. The doctor told Sherrill she suspected that her problem was a severe form of acid reflux known as gastroesophageal reflux disease, or GERD. It occurs when a muscle in the esophagus doesn't close properly, allowing the backflow of stomach contents. Symptoms include frequent heartburn and coughing.

The doctor prescribed a common acid-blocking drug and gave Sherrill a list of things to avoid including wine, coffee and citrus fruit.

Sherrill began taking the drug, which initially seemed to relieve her sore throat, and followed the diet. But she was plagued by a new problem: choking episodes.

Once while cooking dinner, she was munching on raw carrots and suddenly began coughing. "It felt like bits of carrot were stuck in my neck," she said. Another time, she lay down after drinking water, dozed off briefly, and awoke sputtering as water shot out of her nose.

After four months, Sherrill said, she began to doubt the GERD diagnosis. Her acid problem remained, and she didn't think the drug was working. She emailed her doctor and said she wanted to discontinue the medication.

Sherrill decided to take matters into her own hands.

She researched health food remedies and began drinking apple cider vinegar and taking capsules containing orange peel extract, which is advertised as a cure for heartburn.

She hoped they would reduce her now copious production of excess saliva, which caused her to choke when she lay flat or while eating, a reliable pleasure that had become an ordeal.

"I was becoming thin, wiry and hyperactive," Sherrill said.

She bought a 12-inch foam wedge pillow to elevate her head and torso, a remedy recommended to ease reflux. But Sherrill quickly discovered that if she rolled off the pillow during the night, she awoke coughing convulsively.

Stepping on the scale at the gym made her realize she needed to take more effective action. A few days earlier, she had suffered a mortifying choking fit in a restaurant after downing an orange peel capsule. The pill, she said, seemed to detonate in her esophagus, causing her to cough so violently that nearby patrons wanted to call 911.

Sherrill said she flashed on an incident that occurred 15 years earlier when she asked her older brother, whom she saw infrequently, about a scar on his neck. He told her he had undergone surgery to treat choking.

Sherrill immediately sent him a text. Thirty minutes later, to her surprise, he called.

Sherrill's brother advised her to call a patient hotline operated by Kaiser Permanente, the health system both siblings use, and insist on seeing a specialist. The condition he had been treated for was rare, he told her, so it was likely that she had a different problem.

Sherrill called the hotline and emailed her doctor about her worsening condition and her brother's diagnosis. Within hours, she received a referral to a gastroenterologist. He ordered a variety of tests, among them a barium swallow, an imaging test that uses X-rays to inspect the upper gastrointestinal tract.

The reason for Sherrill's problem was immediately apparent. She, too, had Zenker's diverticulum, the same rare disorder as her brother.

Caused by a malfunction in a muscle in the upper esophagus, Zenker's diverticulum is a pouch that forms where the pharynx, or voicebox, meets the esophagus.

Food, liquid and other substances (such as an orange peel capsule) become trapped in the pouch, resulting in choking and aspiration, which can cause pneumonia. Regurgitation can occur minutes or even hours after eating.

The disorder is more common in people over 60 and in those of northern European ancestry. The problem is rare — estimated at 2 in 100,000 people annually in Britain, according to Paula Borges, a head and neck surgeon at Kaiser Permanente Sacramento who treated Sherrill. It is unusual, Borges said, to see cases in siblings.

In Sherrill's case, the pouch was fairly large, and the severity of her symptoms meant surgery was required.

Borges had hoped to treat Sherrill using an endoscopic procedure to eliminate the pouch, a less invasive operation that permits a faster recovery. It didn't work, an outcome that Sherrill had been warned was a possibility. Borges was unable to reach the pouch, which was wedged between two muscles in Sherrill's throat.

A second operation, which involved opening Sherrill's neck, was performed in December 2015. Sherrill spent three days in the hospital and six days on a feeding tube. The operation was a success. Her pain and swallowing difficulty disappeared, and she was able to eat and drink normally, regaining most of the weight she had lost. So far, the problem has not recurred.