<s>[INST] I have a son with Down Syndrome. He has celiac disease. He also has a small esophagus, which has bee nstretched 5 times. It doesn t seem to help. Tonight he started eatin g a gluten free cupcake and he was in the bathroom trying to throw up. I asked him what was wrong and he said he choked on the cake. Is it possible that he has aspirated a crumb or two? He is 41 yrs and is nev er sick - hasn t had even a cold in19 yrs. [/INST] Hello and welcome to HCM,Short esophagus can be the cause of choking.Aspiration is different from choking.Aspiration is food particle entering the trachea and thus lungs.Choking is impaction of food particle in the esophagus.Thus, clinical assessment of the esophagus needs to be done to locate the choked food particle and thus its removal.Thanks and take careDr Shailja P Wahal </s>