Odynophagia

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Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: painful swallowing

Overview

Odynophagia is defined as painful swallowing.

Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order. [1] [2]

Symptoms to Differentiate Odynophagia From

  • Dysphagia is defined as difficulty in swallowing

Diagnosis

History and Symptoms

A directed history should be performed to characterize the following:

  • Onset
  • Severity
  • Duration
  • Dysphagia with liquids versus solids
  • Psychiatric history
  • Prior episodes
  • Substance exposure
  • History of neck and head problems

Laboratory Findings

Electrolyte and Biomarker Studies

  • Creatinine phosphokinase (CPK) can be used to rule out cardiac ischemia as a cause.

Electrocardiogram

Can be used to assess for left atrial enlargement.

Chest X Ray

Can used to rule out lung cancer and other mass lesions as well as left atrial enlargement.

MRI and CT

  • MRI of brain can be used to exclude CVA and mass lesions of the head and neck.

Echocardiography or Ultrasound

Can be used to rule out an aneurysm or left atrial enlargement as a cause.

Other Diagnostic Studies

Treatment

  • Endoscopy (acute and chronic mechanical obstructions)
  • Speech therapy (ALS and stroke patients)

Pharmacotherapy

  • Proton pump inhibitors or promotility agents, weight loss, avoidance of offending foods (gastroesophageal reflux disease)
  • Anticholinergics (ALS, stroke, lower esophageal spasms)
  • Muscarinic agents (myasthenia gravis)
  • Glucocorticoids (myasthenia gravis and polymyositis)
  • Antispasmodics, botulinum toxin injection (lower esophageal spasm)

Surgery and Device Based Therapy

  • Thoracic surgery, possible balloon dilation (chronic mechanical obstruction)

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X


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