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| {{Search infobox}}
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| {{CMG}}
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| {{SK}} painful swallowing | | '''For patient information on this topic, click [[odynophagia (patient information)|here]].''' |
| | {{Odynophagia}} |
| | {{CMG}}; {{AE}} {{SKA}} |
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| ==Overview==
| | {{SK}} Painful swallowing, Pain during swallowing, Odenophagia, Odinophagia, Odenophagia. |
| '''Odynophagia''' is defined as painful swallowing.
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| == Causes== | | ==[[Odynophagia overview|Overview]]== |
| ===Common Causes===
| | ==[[Odynophagia historical perspective|Historical Perspective]]== |
| * [[Upper respiratory tract infections]]
| | ==[[Odynophagia pathophysiology|Pathophysiology]]== |
| * [[Achalasia cardia]]
| | ==[[Odynophagia causes|Causes]]== |
| * [[Scleroderma]]
| | ==[[Odynophagia differential diagnosis|Differentiating Odynophagia from other Conditions]]== |
| * [[Zenkers diverticulum]]
| | ==[[Odynophagia epidemiology and demographics|Epidemiology and Demographics]]== |
| * [[Esophageal cancer]]
| | ==[[Odynophagia risk factors|Risk Factors]]== |
| * [[Myasthenia gravis]]
| | ==[[Odynophagia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * [[Tonsillitis]]
| | ==Diagnosis== |
| ===Causes by Organ System===
| | [[Odynophagia history and symptoms|History and Symptoms]] | [[Odynophagia physical examination|Physical Examination]] | [[Odynophagia laboratory findings|Laboratory Findings]] | [[Odynophagia electrocardiogram|Electrocardiogram]] | [[Odynophagia chest x ray|Chest X Ray]] | [[Odynophagia CT|CT]] | [[Odynophagia MRI|MRI]] | [[Odynophagia echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Odynophagia other imaging findings|Other Imaging Findings]] | [[Odynophagia other diagnostic studies|Other Diagnostic Studies]] |
| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aortic aneurysm]], [[Double aortic arch]], [[Enlarged left atrium]], [[Mediastinitis]], [[Mitral valve stenosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| [[Botulism]], [[Chemical burns]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| [[Scleroderma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Stevens-Johnson Syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| [[Cricopharyngeal spasm]], [[Epiglottitis]], [[Esophagotracheal fistula]], [[Glossitis]], [[Goiter]], [[Gum disease]], [[Laryngitis]], [[Oral submucous fibrosis]], [[Oral ulcers]], [[Palatoplegia]], [[Stomatitis]], [[Zenker's Diverticulum]], [[Herpangina]], [[Retropharyngeal abscess ]], [[Palate cancer]], [[Supraglottic laryngeal cancer ]], [[Xerostomia]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Diabetic neuropathy]], [[Hyperthyroidism]], [[Hypothyroidism]], [[Riedel thyroiditis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Achalasia]], [[Barrett's oesophagus]], [[Diverticulum]], [[Esophageal achalasia]], [[Esophageal atresia]], [[Esophageal spasm]], [[Esophageal stricture ]], [[Esophagitis ]], [[Fibrosis]], [[Gastritis]], [[Gastroesophageal reflux]], [[Intramural pseudodiverticulosis]], [[Peptic stenosis]], [[Schatzki ring]], [[Myoneurogastrointestinal encephalopathy syndrome]], [[Crohn's disease]], [[Eosinophilic esophagitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Opitz-Frias syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| [[Agranulocytosis]], [[Lymphadenopathy]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| [[Radiation esophagitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Abscesses]], [[Acute pharyngitis ]], [[Adenoiditis]], [[Angina tonsillaris]], [[Candidiasis]], [[Chagas Disease]], [[Cytomegalovirus ]], [[Diphtheria]], [[Esophageal moniliasis]], [[Flu]], [[Herpangina]], [[Herpes simplex virus (HSV)]], [[Herpes stomatitis ]], [[HIV/AIDS]], [[Mononucleosis]], [[Mumps]], [[Oral candidiasis]], [[Paracoccidioidomycosis]], [[Pharyngitis]], [[Poliomyelitis]], [[Rabies]], [[Reflux esophagitis]], [[Respiratory tract infections ]], [[Retropharyngeal abscess ]], [[Scarlet Fever]], [[Tetanus]], [[Tonsillar abscess]], [[Tooth infection]], [[Typhoid fever]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| [[Elongated styloid process]], [[Extreme spinal curvature]], [[Global hystericus]], [[Schatzki ring]], [[Leiomyoma]], [[Dermatomyositis]], [[Myasthenia Gravis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Amyotrophic Lateral Sclerosis (ALS)]], [[Brainstem stroke]], [[Bulbar palsy]], [[Central hypoglossal nerve paralysis]], [[Central vagal nucleus lesion]], [[Cerebrovascular accident]], [[Guillain-Barre syndrome]], [[Huntington's chorea]], [[Multiple Sclerosis]], [[Myoneurogastrointestinal encephalopathy syndrome]], [[Neuroferritinopathy]], [[Peripheral neuropathy]], [[Polyradiculitis]], [[Syringobulbia]], [[Vagal disorder]], [[Diabetic neuropathy]], [[Poliomyelitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Gaucher's disease]], [[Plummer-Vinson Syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Bronchial carcinoma]], [[Carcinoma of the vocal tract ]], [[Carotid body tumor]], [[Esophageal cancer]], [[Gastric tumors]], [[Hypopharyngeal cancer ]], [[Laryngeal cancer]], [[Leiomyoma]], [[Oral cancer ]], [[Palate cancer]], [[Paraneoplastic syndrome]], [[Supraglottic laryngeal cancer ]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| [[Anxiety disorders]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Bronchial carcinoma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Allergic swelling]], [[Amyloidosis]], [[Behcet's Syndrome]], [[CREST syndrome ]], [[Crohn's disease]], [[Dermatomyositis]], [[Eosinophilic esophagitis]], [[Esophageal sarcoidosis]], [[Graft versus host reaction]], [[Inclusion body myositis]], [[Myasthenia Gravis]], [[Parkinson's Disease]], [[Riedel thyroiditis]], [[Rheumatoid Arthritis]], [[Scleroderma]], [[Systemic Lupus Erythematosus]], [[Systemic sclerosis]], [[Xerostomia]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| [[Esophageal trauma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| [[Alcoholism]], [[Aspiration of foreign body]]
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| |-
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| |}
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| ===Causes in Alphabetical Order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>=== | | ==Treatment== |
| * [[Abscesses]]
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| * [[Achalasia]]
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| * [[Acute pharyngitis ]]
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| * [[Adenoiditis]]
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| * [[Agranulocytosis]]
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| * [[Alcoholism]]
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| * [[Allergic swelling]]
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| * [[Amyloidosis]]
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| * [[Amyotrophic Lateral Sclerosis (ALS)]]
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| * [[Angina tonsillaris]]
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| * [[Anxiety disorders]]
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| * [[Aortic aneurysm]]
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| * [[Aspiration of foreign body]]
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| * [[Barrett's oesophagus]]
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| * [[Behcet's Syndrome]]
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| * [[Botulism]]
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| * [[Brainstem stroke]]
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| * [[Bronchial carcinoma]]
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| * [[Bulbar palsy]]
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| * [[Candidiasis]]
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| * [[Carcinoma of the vocal tract ]]
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| * [[Carotid body tumor]]
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| * [[Central hypoglossal nerve paralysis]]
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| * [[Central vagal nucleus lesion]]
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| * [[Cerebrovascular accident]]
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| * [[Chagas Disease]]<ref>http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002348/</ref>
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| * [[Chemical burns]]
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| * [[CREST syndrome ]]
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| * [[Cricopharyngeal spasm]]
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| * [[Crohn's disease]]
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| * [[Cytomegalovirus ]]
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| * [[Dermatomyositis]]
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| * [[Diabetic neuropathy]]
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| * [[Diphtheria]]
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| * [[Diverticulum]]
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| * [[Double aortic arch]]
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| * [[Elongated styloid process]]
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| * [[Enlarged left atrium]]
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| * [[Eosinophilic esophagitis]]
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| * [[Epiglottitis]]
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| * [[Esophageal achalasia]]
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| * [[Esophageal atresia]]
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| * [[Esophageal cancer]]
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| * [[Esophageal moniliasis]]
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| * [[Esophageal spasm]]
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| * [[Esophageal stricture ]]
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| * [[Esophageal trauma]]
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| * [[Esophageal sarcoidosis]]
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| * [[Esophagitis ]]
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| * [[Esophagotracheal fistula]]
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| * [[Extreme spinal curvature]]
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| * [[Fibrosis]]
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| * [[Flu]]
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| * [[Gastric tumors]]
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| * [[Gastritis]]
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| * [[Gastroesophageal reflux]]
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| * [[Gaucher's disease]]<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018671/</ref>
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| * [[Global hystericus]]<ref>http://www.ncbi.nlm.nih.gov/pubmed/6875362</ref>
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| * [[Glossitis]]
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| * [[Goiter]]
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| * [[Graft versus host reaction]]
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| * [[Guillain-Barre syndrome]]
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| * [[Gum disease]]
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| * [[Herpangina]]
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| * [[Herpes simplex virus (HSV)]]
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| * [[Herpes stomatitis ]]
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| * [[HIV/AIDS]]
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| * [[Huntington's chorea]]
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| * [[Hyperthyroidism]]
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| * [[Hypopharyngeal cancer ]]
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| * [[Hypothyroidism]]
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| * [[Inclusion body myositis]]
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| * [[Intramural pseudodiverticulosis]]
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| * [[Intramural pseudodiverticulosis]]
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| * [[Laryngeal cancer]]
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| * [[Laryngitis]]
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| * [[Leiomyoma]]
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| * [[Lymphadenopathy]]
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| * [[Mediastinitis]]
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| * [[Mitral valve stenosis]]
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| * [[Mononucleosis]]
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| * [[Multiple Sclerosis]]
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| * [[Mumps]]
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| * [[Myasthenia Gravis]]
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| * [[Myoneurogastrointestinal encephalopathy syndrome]]<ref>http://ghr.nlm.nih.gov/condition/mitochondrial-neurogastrointestinal-encephalopathy-disease</ref>
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| * [[Neuroferritinopathy]]<ref>http://www.ncbi.nlm.nih.gov/books/NBK1141/</ref>
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| * [[Opitz-Frias syndrome]]<ref>http://www.ncbi.nlm.nih.gov/books/NBK1523/</ref>
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| * [[Oral cancer ]]
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| * [[Oral submucous fibrosis]]
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| * [[Oral ulcers]]
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| * [[Oral candidiasis]]
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| * [[Palate cancer]]
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| * [[Palatoplegia]]
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| * [[Paracoccidioidomycosis]]
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| * [[Paraneoplastic syndrome]]
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| * [[Parkinson's Disease]]
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| * [[Peptic stenosis]]
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| * [[Peripheral neuropathy]]
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| * [[Pharyngitis]]
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| * [[Plummer-Vinson Syndrome]]
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| * [[Poliomyelitis]]
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| * [[Polyradiculitis]]
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| * [[Rabies]]
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| * [[Radiation esophagitis]]
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| * [[Reflux esophagitis]]
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| * [[Respiratory tract infections ]]
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| * [[Retropharyngeal abscess ]]
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| * [[Rheumatoid Arthritis]]
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| * [[Riedel thyroiditis]]
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| * [[Scarlet Fever]]
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| * [[Schatzki ring]]
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| * [[Scleroderma]]
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| * [[Stevens-Johnson Syndrome]]
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| * [[Stomatitis]]
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| * [[Supraglottic laryngeal cancer ]]
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| * [[Syringobulbia]]
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| * [[Systemic Lupus Erythematosus]]
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| * [[Systemic sclerosis]]
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| * [[Tetanus]]
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| * [[Tonsillar abscess]]
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| * [[Tooth infection]]
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| * [[Typhoid fever]]
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| * [[Vagal disorder]]
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| * [[Xerostomia]]
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| * [[Zenker's Diverticulum]]
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| ==Symptoms to Differentiate Odynophagia From==
| | [[Odynophagia medical therapy|Medical Therapy]] | [[Odynophagia surgery|Surgery]] | [[Odynophagia primary prevention|Primary Prevention]] | [[Odynophagia secondary prevention|Secondary Prevention]] | [[Odynophagia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Odynophagia future or investigational therapies|Future or Investigational Therapies]] |
| * [[Dysphagia]] is defined as difficulty in swallowing
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| == Diagnosis == | | ==Case Studies== |
| | | [[Odynophagia case study one|Case #1]] |
| === History and Symptoms ===
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| A directed history should be performed to characterize the following:
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| * Onset
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| * Severity
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| * Duration
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| * Dysphagia with liquids versus solids
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| * Psychiatric history
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| * Prior episodes
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| * Substance exposure
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| * History of neck and head problems
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| === Laboratory Findings ===
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| ==== Electrolyte and Biomarker Studies ====
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| * Creatinine phosphokinase (CPK) can be used to rule out cardiac ischemia as a cause.
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| === Electrocardiogram ===
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| Can be used to assess for [[left atrial enlargement]].
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| === Chest X Ray ===
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| Can used to rule out lung cancer and other mass lesions as well as left atrial enlargement.
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| === MRI and CT ===
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| * MRI of brain can be used to exclude CVA and mass lesions of the head and neck.
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| === Echocardiography or Ultrasound ===
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| Can be used to rule out an aneurysm or left atrial enlargement as a cause.
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| === Other Diagnostic Studies ===
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| * [[Esophagogastroduodenoscopy]] (OGD)
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| * [[Biopsy]]
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| * [[Barium swallow]]
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| * [[Electromyogram]] ([[EMG]])
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| * Nerve conduction tests
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| * Esophageal manometry
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| == Treatment ==
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| * Endoscopy (acute and chronic mechanical obstructions)
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| * Speech therapy (ALS and stroke patients)
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| == Pharmacotherapy ==
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| * Proton pump inhibitors or promotility agents, weight loss, avoidance of offending foods (gastroesophageal reflux disease)
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| * Anticholinergics (ALS, stroke, lower esophageal spasms)
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| * Muscarinic agents (myasthenia gravis)
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| * Glucocorticoids (myasthenia gravis and polymyositis)
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| * Antispasmodics, botulinum toxin injection (lower esophageal spasm)
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| == Surgery and Device Based Therapy ==
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| * Thoracic surgery, possible balloon dilation (chronic mechanical obstruction)
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| == References ==
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| {{Reflist|2}}
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Musculoskeletal Disease]] | | [[Category:Musculoskeletal Disease]] |
| | [[Category:Symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
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