Odynophagia overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

Odynophagia is defined as painful swallowing. It is caused by various medical conditions. It should not be confused with dysphagia, which stands for difficulty in swallowing. Common causes of odynophagia are throat infections, foreign body, acid reflex disease, tumors, or injuries.It may lead to difficulty in swallowing due to disturbing pain.

Historical Perspective

Odynophagia is a Greek word. (/oʊ-dɪnˈə-feɪˈjəˌ-jiː-ə/; from odyno- "pain" and phagō "to eat") is pain when swallowing.

Other than that there is no specific historical background of odynophagia.

Classification

There is no established system for the classification of odynophagia. However we can classify them according to causes to approach the area of involvement..

Odynophagia may be classified according to causes into two groups:

• Disorders of esophagus
• Disorders of pharynx

Pathophysiology

The pain in swallowing is induced due to conditions causing stimulation of sensory nerves innervating esophagus and pharynx.

Infections:

Infection of esophagus or pharynx causes fluid leaking in interstitial media of mucous epithelium and it produce pressure on sensory nerve terminals situated in mucousa.

Tumors:

It produce pain due to compression effect of mass on sensory nerve terminals situated in mucousa.

Foreign body:

It produce pain due to compression effect of foreign body on sensory nerve terminals situated in mucousa.

Causes

• Achalasia cardia
• Esophageal cancer
• Myasthenia gravis
• Scleroderma
• Tonsillitis
• Upper respiratory tract infections
• Zenkers diverticulum
• Gastroesophageal reflux disease

Differentiating Odynophagia from other Conditions

The causes of odynophagia are of various pathologies. Differentiating them with adjacent history and examination is helpful to narrow down the exact pathology.

Causes	Pain	History finding	Examination finding	Diagnostic test
URTI	Acute pain	Changed in voice, fever, runny nose	inflamed oral mucosa, enlarged lymph nodes or tonsils	Oral swab culture
Tumors	Dull Pain	Loss of weight and appetite, risk factors, may have dysphagia	swelling may be seen, tumor may spread to lymph nodes	Endoscopy
Foreign body	Acute pain	History of foreign body intake	Foreign body may be seen, surrounding area may be inflamed	Laryngoscopy
GERD	Buring pain	Pain worse at nights,decrease food intake but normal appetite	oral mucousa normal, mild tender epigastrium	manomatary
Esophagitis	Burning pain	Resternal pain on swallowing, food aversion, risk factor	oral mucosa normal	Endoscopy

Epidemiology and Demographics

Common causes of odynophagia have their indepndent statcis. The common causes are

Pharyngitis:

Incidence

• 2015 In the USA, the prevalence of Pharyngitis 4.8 per 100,000 people with group A strep."ABCs | Bacterial Surveillance | 2015 GAS Report | CDC".

GERD:

Prevalence

• In the USA and Europe, the prevalence of GERD ranges from low of 10,000 per 100,000 persons to high of 20,000 per 100,000 people. [1]
• In Asia, the prevalence of GERD is 5,000 per 100,000 people.

Incidence

• In the USA, the incidence of GERD is 5,400 per 100,000 persons.
• In Europe, the incidence of GERD is 840 per 100,000 persons.

Esophagitis:

Prevalence

• In the USA and Europe, the prevalence of esophagitis ranges from low of 10,000 per 100,000 persons to high of 20,000 per 100,000 people..
• In Asia, the prevalence of esophagitis is 5,000 per 100,000 people.
• The prevalence of EoE is approximately 50-100 per 100,000 individuals worldwide.

Incidence

• In the USA, the incidence of esophagitis is 5,400 per 100,000 persons.
• In Europe, the incidence of esophagitis is 840 per 100,000 persons.
• The incidence of EoE is approximately 10 per 100,000 individuals worldwide.

Diagnosis

To diagnose odynophagia history, examinations and in difficult scenarios scope of larynx and pharynx may be required to reach the correct diagnosis.

Treatment

Treatment of painful swalllowing is depending on treating the primary causes. However some of cases obtain benefit of using soothing agents as marshmallow plant, Sage and echinacea, Apple cider vinegar, Salt water gargle,Honey, Licorice root,Lemon water, Ginger root tea, Coconut oil, Cinnamon, Plenty of fluids, Chicken soup, Peppermint tea, Chamomile tea and Herbal throat lozenges.