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 Aortic aneurysm, Double aortic arch, Enlarged left atrium, Mediastinitis, Mitral valve stenosis
Chemical / poisoning Botulism, Chemical burns
Dermatologic Scleroderma
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, Herpangina, Retropharyngeal abscess , Palate cancer, Supraglottic laryngeal cancer , Xerostomia
Endocrine Diabetic neuropathy, Hyperthyroidism, Hypothyroidism, Riedel thyroiditis
Environmental No underlying causes
Gastroenterologic 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
Genetic Opitz-Frias syndrome
Hematologic Agranulocytosis, Lymphadenopathy
Iatrogenic Radiation esophagitis
Infectious Disease 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
Musculoskeletal / Ortho Elongated styloid process, Extreme spinal curvature, Global hystericus, Schatzki ring, Leiomyoma, Dermatomyositis, Myasthenia Gravis
Neurologic 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
Nutritional / Metabolic Gaucher's disease, Plummer-Vinson Syndrome
Obstetric/Gynecologic No underlying causes
Oncologic 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
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric Anxiety disorders
Pulmonary Bronchial carcinoma
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy 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
Sexual No underlying causes
Trauma Esophageal trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Alcoholism, Aspiration of foreign body

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
  3. ↑ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002348/
  4. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018671/
  5. ↑ http://www.ncbi.nlm.nih.gov/pubmed/6875362
  6. ↑ http://ghr.nlm.nih.gov/condition/mitochondrial-neurogastrointestinal-encephalopathy-disease
  7. ↑ http://www.ncbi.nlm.nih.gov/books/NBK1141/
  8. ↑ http://www.ncbi.nlm.nih.gov/books/NBK1523/


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