Odynophagia

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

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

Causes by Organ System

Cardiovascular	Aortic aneurysm, Double aortic arch, Enlarged left atrium, Mediastinitis, Mitral valve stenosis
Chemical / poisoning	Botulism, Chemical burns
Dermatologic	No underlying causes
Drug Side Effect	Stevens-Johnson Syndrome
Ear Nose Throat	Cricopharyngeal spasm, Epiglottitis, Esophagotracheal fistula, Glossitis, Goiter, Gum disease, Laryngitis, Oral submucous fibrosis, Oral ulcers, Palatoplegia, Stomatitis, Zenker's Diverticulum
Endocrine	Diabetic neuropathy, Hyperthyroidism, Hypothyroidism, Riedel thyroiditis
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

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

• Esophagogastroduodenoscopy (OGD)
• Biopsy
• Barium swallow
• Electromyogram (EMG)
• Nerve conduction tests
• Esophageal manometry

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

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