Gagging Test

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Gagging Test
Read about What Causes Gagging & Common Gagging Symptoms
Resident at Children Hospital of Philadelphia
Associate Professor of Medicine, Brigham and Women’s Hospital
Resident at Children Hospital of Philadelphia
Associate Professor of Medicine, Brigham and Women’s Hospital
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Autoimmune inflammation of the esophagus
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Associate Professor of Medicine, Brigham and Women’s Hospital
Abdominal pain is usually a sign of a common illness or infection. Other causes include indigestion, a stomach ulcer, IBS, or food poisoning.
Nausea is that queasy feeling in your stomach that makes you feel like you're going to vomit. Usually, nausea is from an infection, pregnancy, taking certain medication, or acid reflux.
Your cough can be caused by viruses, bacterial infections, COVID-19, allergies, and a number of other conditions. Learn what your cough symptoms mean, how to get the right diagnosis, and what treatments actually help.
Abdominal pain is usually a sign of a common illness or infection. Other causes include indigestion, a stomach ulcer, IBS, or food poisoning.
Nausea is that queasy feeling in your stomach that makes you feel like you're going to vomit. Usually, nausea is from an infection, pregnancy, taking certain medication, or acid reflux.
Your cough can be caused by viruses, bacterial infections, COVID-19, allergies, and a number of other conditions. Learn what your cough symptoms mean, how to get the right diagnosis, and what treatments actually help.
Abdominal pain is usually a sign of a common illness or infection. Other causes include indigestion, a stomach ulcer, IBS, or food poisoning.
Nausea is that queasy feeling in your stomach that makes you feel like you're going to vomit. Usually, nausea is from an infection, pregnancy, taking certain medication, or acid reflux.
Your cough can be caused by viruses, bacterial infections, COVID-19, allergies, and a number of other conditions. Learn what your cough symptoms mean, how to get the right diagnosis, and what treatments actually help.
Take a quiz to find out what's causing your gagging.
Gagging is usually caused by any foreign body that will irritate the lungs or bronchial tree. Acid reflux (GERD), inflammation of the epiglottis, or a mini stroke can cause a gag reflex. Read below for more information on causes and treatment options.
Take a quiz to find out what's causing your gagging.
The definition of "gag" or " gagging " is to suffer a throat spasm that makes swallowing or breathing difficult . Some people also associate "gagging" with dry heaving or retching, which is the sensation or feeling of vomiting without getting rid of any stomach contents.
These conditions are reflexes triggered when your airway closes while your diaphragm contracts. Gagging is often a normal defense mechanism your body uses to protect itself from potentially dangerous substances; however, sometimes gagging can signal a more serious underlying problem.
Symptoms that can be associated with gagging may include:
It is important to follow-up on your symptoms with your physician in order to get appropriate an diagnosis and care.
The proximal airway (or upper respiratory system) is composed of the nose, mouth, and throat. It connects to the lower respiratory system that includes the trachea, lungs, and segments (bronchial tree) that bring oxygen to these areas.
Gagging can be caused by any irritant that enters the airway and aggravates the lungs and bronchial tree. These irritants cause the airway to close-off as a means of protecting the body from potentially dangerous elements. Oxygen is temporarily blocked from coming into the body, and in turn, the diaphragm contracts as a means of allowing the lungs to expand and let in oxygen, even though there is none actually coming in.
Specific conditions that can lead to gagging are described below, including those are gastrointestinal, infection-related, environmental, and mechanical.
The digestive tract is composed of acids and enzymes for digesting food. The digestive tract is designed to be able to withstand these substances; however, the airway and esophagus are not accustomed. The stomach is meant to keep these acids from moving back up through the esophagus and causing irritation; however, these processes are not always perfect. When partially digested foods or acids improperly go back up the esophagus (GERD), symptoms such as discomfort, difficulty breathing, heartburn, and gagging can result.
The respiratory tract is extremely susceptible to infection due to its direct contact with the environment.
Just as bacteria can easily enter the upper respiratory tract, other substances from the environment (either intentionally or unintentionally) can enter the body and cause gagging.
Take a quiz to find out what's causing your gagging.
Causes that are mechanical in nature may involve the following.
This list does not constitute medical advice and may not accurately represent what you have.
Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It is a potentially life-threatening medical condition.
Top Symptoms: sore throat, loss of appetite, fever, shortness of breath, being severely ill
Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.
Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.
Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.
A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.
Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.
Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck
Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness
Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It is a potentially life-threatening medical condition.
This is a medical emergency. Please seek out urgent care at your closest Emergency Department today. Diagnosis is done with imaging. Treatment is immediate surgical drainage and antibiotics.
Epiglottitis is inflammation of the epiglottis, tissue that covers the trachea (windpipe), which helps prevent coughing or choking after swallowing. It is usually caused by the bacteria H. Influenzae but can also be caused by other bacteria or viruses that cause upper respiratory infections.
Call 911 immediately for an ambulance now! Epiglottis can be a life-threatening emergency. Though with proper treatment at a hospital, the outcome is usually good.
Top Symptoms: being severely ill, shortness of breath, fever, sore throat, pain with swallowing
Symptoms that never occur with inflammation of the epiglottis: cough
Guillain-Barre syndrome is an autoimmune condition triggered by infection. It causes damage to nerves in the body that control muscles. This leads to weakness, usually starting in the legs and then progressing to the arms.
Patients with Guillain-Barre syndrome should seek immediate medical care at an ER. Nerve damage can potentially impair your ability to control your heart and lungs. You may need to be admitted to the hospital.
When a non-food object is ingested, it can have unpredictable and potentially dangerous effects on the body.
You need to speak with a doctor to discuss whether the foreign object should be removed or allowed to pass through the digestive system. Often, the physician will want to take x-rays and closely monitor any changes in your GI tract.
Top Symptoms: vomiting, deep chest pain, behind the breast bone, trouble swallowing, swallowing of something potentially harmful, gagging
Symptoms that always occur with foreign body ingestion: swallowing of something potentially harmful
Symptoms that never occur with foreign body ingestion: choking
This condition, officially known as eosinophilic esophagitis, occurs when a certain type of white blood cell (eosinophil) builds up in the lining of the tube that connects the mouth to the stomach. The buildup leads to inflammation of the tissue, causing pain and difficulty swallowing.
You should visit your primary care physician to treat this condition. This is an immune disorder and is commonly treated with corticosteroids.
Amyotrophic lateral sclerosis is also called ALS or Lou Gehrig's Disease. It is a degenerative disease that destroys nerve cells, which eventually leads to loss of control over muscle function.
The cause of ALS is not known. It may be inherited and/or due to a chemical imbalance, faulty autoimmune response, or exposure to toxic environmental agents.
Symptoms include weakness; difficulty with speaking, swallowing, walking, or using the hands; and muscle cramps. The muscles of the arms, hands, legs, and feet are most involved at first. It does not affect the senses or a person's mental ability.
ALS is progressive, meaning it worsens over time. There is no cure, but supportive care can keep the patient comfortable and improve quality of life.
Diagnosis is made through several tests including blood tests; urine tests; MRI; electromyography (EMG) to measure muscle activity; nerve conduction studies; and sometimes muscle biopsy or spinal tap (lumbar puncture.)
Treatment involves medications to both slow the progression of the disease and ease the symptoms; respiratory therapy; physical therapy; occupational therapy; and psychological support.
Gastroesophageal reflux disease is also called GERD , acid reflux disease, and heartburn. It is caused by a weakening in the muscle at the end of esophagus. This allows stomach acid to flow backward, or reflux, up into the esophagus.
Risks factors for GERD include obesity, smoking, diabetes, hiatal hernia, and pregnancy.
Symptoms include a painful burning sensation in the chest and throat, and sometimes difficulty swallowing.
If heartburn occurs more than twice a week, a doctor should be consulted. If symptoms are accompanied by jaw or arm pain, and/or shortness of breath, these may be signs of a heart attack and constitute a medical emergency.
Repeated exposure to stomach acid damages the lining of the esophagus, causing bleeding, pain, and scar tissue.
Diagnosis is made by patient history and sometimes by x-ray, upper endoscopy, or other tests to measure refluxed acid.
Treatment begins with over-the-counter antacids and lifestyle changes. Medication may be used to reduce stomach acid, and surgery may be done to strengthen the sphincter muscle at the lower end of the esophagus.
Take a quiz to find out what's causing your gagging.
As long as gagging is not causing severe difficulty breathing, treatment can begin at home. If incidents of gagging increase in frequency or severity, you should consult your physician.
Home remedies and lifestyle changes are often the first lines of treatment for gagging. Try the following suggestions to help alleviate your symptoms:
Though most cases of gagging do not require emergency treatment, prompt medical attention is necessary when your symptoms do not resolve on their own. See your physician especially if:
Seek emergency treatment if along with your gagging you experience the following. These may be a sign of a more serious condition:
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
The content available on buoy.com is not a substitute for professional medical advice, diagnosis, or treatment.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation
July 4, 2017 by Josh Farkas 5 Comments
As a medical student I rotated through an elite hospital where it was believed that every patient admitted to the medicine service needed a rectal exam. The rationale was to avoid ever missing a case of rectal or prostate cancer. Eventually, the utility of digital rectal examination as a cancer-screening tool was debunked. Thankfully, this practice has fallen out of favor.
Checking gag reflexes seems like a similar practice: an uncomfortable test which is engrained in our practice during training. Despite evidence that it's unhelpful, it continues to be commonly performed. This post pushes back against the practice of gagging patients by proposing an extreme viewpoint: this test should be abandoned in living patients.
The pharyngeal reflex involves stimulating the posterior pharynx, which will usually elicit a reflexive constriction of the pharynx with elevation of the uvula. Sensation is predominantly due to CN IX (glossopharyngeal nerve), whereas the pharyngeal musculature is mostly controlled by CN X (vagus nerve). However, this division isn't absolute; in particular, the pharyngeal muscles are enervated by both nerves. More sensitive patients also gag in response to stimulation of the soft palate, which is enervated by cranial nerve V (trigeminal).
The pharyngeal reflex should be dissected into two components:
The gag reflex appears to always be accompanied by the palatal reflex. However, normal patients often lack a gag reflex, despite retaining a palatal reflex ( Lim 2009 ). The palatal reflex seems to be more hard-wired, whereas the gag reflex may be more susceptible to influence from higher brain centers (e.g. emotional inputs, habituation). The palatal reflex is probably a better indicator of true pathology. However, the gag reflex is more dramatic and thus has received far more attention.
There is no standardization of how the gag reflex is tested:
Davies 1995 found that inter-observer agreement was poor even within a single research study using a standardized protocol (agreement in only 10/15 patients, which isn't much better than pure chance). In clinical practice reproducibility is probably even worse, because clinicians use a variety of different techniques.
If it were perfectly specific, the gag reflex would be present in 100% of patients without neurologic disease. However, healthy people frequently lack a gag reflex. The table below shows the frequency of absent gag reflex among neurologically normal individuals (1):
There is enormous variability in the frequency of absent gag reflex. This may partially reflect different patient populations, with gag reflex less common among the elderly or patients with sleep apnea ( Valbuza 2011 ). It may also partially reflect different techniques used to elicit the reflex. Regardless, the specificity is poor and non-reproducible.
The greatest amount of evidence about the gag reflex regards its ability to predict aspiration. Several studies have found that the gag reflex has little relationship to aspiration, for example:
A poor relationship between gagging and aspiration may seem counterintuitive, but this is easily explained. Gagging seems evolutionarily designed to prevent choking on large pieces of food, not to prevent liquid aspiration. Avoiding aspiration of liquids requires reflexive swallowing , a far more complex maneuver involving five cranial nerves and 26 muscles . Thus, it is entirely possible for a patient to have an intact gag reflex, yet freely aspirate liquids.
There are several reasons that the gag reflex shouldn't be used to determine whether a patient is able to protect their airway from aspiration:
Experts have cautioned against using the gag reflex to evaluate airway protection for decades ( Mackway-Jones 1999 ). Unfortunately, knowledge translation has been sluggish:
Although it persists, inexplicably, in clinical practice, the gag reflex largely has disappeared from research evaluations -Walls Manual of Emergency Airway Management, 4th edition Airway Manual, 4th edition 2012 .
The gag reflex is a traditional component of the neurologic examination to evaluate the brainstem. I couldn't find any large studies regarding the performance of the gag reflex for detection of focal neurologic lesions. Most commonly a single gag maneuver is performed, which probably has poor performance:
If we estimate that a single gag reflex has a sensitivity of ~50% and specificity of ~75%, this would give it a positive likelihood ratio of 1.7 and a negative likelihood ratio of 0.7. These performance characteristics cannot justify the time and discomfort involved in performing the test.
What about checking bilateral gag reflexes? A unilaterally absent gag reflex might be expected to have greater specificity for focal pathology. However, a unilaterally absent gag was found among 4/138 of normal people by Davies 1995 . Although this rate is low, it would still be higher than the rate of occult brainstem pathology – so that a unilaterally absent gag would still probably represent a red herring.
CN IX and X are very close to each other, with diseases often involving both nerves together. For a general neurologic examination, the following tests may be more humane and more replicable than the gag reflex:
We are legally required to confirm the absence of a gag reflex in every patient who is declared brain dead. This is a sensible practice, because the presence of a gag reflex would indicate brainstem function and thereby disprove brain death. This is the only situation where the gag reflex is a highly specific test (2). Thus, the brain-dead patient is the last bastion of clinical utility for the gag reflex.
How do you know if they’re going to accept an OPA during respiratory arrest then? Just stick it in? Wait to paralyze them?
If there is a possibility that the patient will vomit (e.g. not paralyzed), then it may be safer to use a nasopharyngeal airway.
We live in the era of Evidence Based Medicine(EBM). If we limit
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