Endoscopy and gagging

Teodor C. Pitea, MD, is a gastroenterologist and therapeutic endoscopist at Banner Del E. Webb Medical Center.

Question: I have to get an endoscopy done and am worried about gagging. Is there a way to avoid this?

Answer: The gag reflex, known medically as the pharyngeal reflex, is a contraction of the back of the throat that occurs when certain areas of the inside of the mouth are touched, including the roof of the mouth, back of the tongue or throat, and the area around the tonsils. Your question is a common one, especially from individuals who gag easily and have what is considered a hypersensitive gag reflex. This sensitivity can lead to significant difficulties with swallowing pills, and tolerating dental work and endoscopic examinations.

Having a hypersensitive gag reflex is generally a conditioned response, meaning it happens after a previous problematic experience. However, the discomfort related to gagging during an endoscopic procedure can be avoided, particularly by numbing the back of the throat and using sedatives.

If you are concerned about gagging during an endoscopic procedure, talk with your doctor beforehand to understand the whole process and reduce any anxiety you are feeling. Your doctor and his or her staff can discuss ways to increase your overall comfort level.

Immediately before the procedure, your physician or a nurse anesthetist will spray the back of your throat with a local anesthetic. This will numb your throat before the small, flexible tube called an endoscope is introduced. All endoscopic procedures involve some degree of sedation, which relaxes you and subdues your gag reflex. Being sedated during the procedure will put you into a moderate to deep sleep, so you will not feel any discomfort when the endoscope is inserted through the mouth and into the stomach. Moreover, most people undergoing sedation will have some short-term memory loss, so you will not recall the examination itself. This memory loss is very helpful in reducing anxiety about future procedures.

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