Odynophagia

Odynophagia Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Odynophagia from other Conditions
Epidemiology and Demographics
Screening
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Synonyms and keywords: painful swallowing, pain during 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	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

Abscesses Achalasia Acute pharyngitis Adenoiditis Agranulocytosis Alcoholism Allergic swelling Amyloidosis Amyotrophic Lateral Sclerosis (ALS) Angina tonsillaris Anxiety disorders Aortic aneurysm Aspiration of foreign body Barrett's oesophagus Behcet's Syndrome Botulism Brainstem stroke Bronchial carcinoma Bulbar palsy Candidiasis Carcinoma of the vocal tract Carotid body tumor Central hypoglossal nerve paralysis Central vagal nucleus lesion Cerebrovascular accident Chagas Disease Chemical burns CREST syndrome Cricopharyngeal spasm Crohn's disease Cytomegalovirus Dermatomyositis Diabetic neuropathy Diphtheria Diverticulum Double aortic arch Elongated styloid process Enlarged left atrium Eosinophilic esophagitis Epiglottitis Esophageal achalasia Esophageal atresia Esophageal cancer Esophageal moniliasis Esophageal spasm Esophageal stricture Esophageal trauma Esophageal sarcoidosis Esophagitis Esophagotracheal fistula Extreme spinal curvature Fibrosis Flu Gastric tumors Gastritis Gastroesophageal reflux Gaucher's disease Global hystericus Glossitis Goiter Graft versus host reaction Guillain-Barre syndrome

Gum disease Herpangina Herpes simplex virus (HSV) Herpes stomatitis HIV/AIDS Huntington's chorea Hyperthyroidism Hypopharyngeal cancer Hypothyroidism Inclusion body myositis Intramural pseudodiverticulosis Laryngeal cancer Laryngitis Leiomyoma Lymphadenopathy Mediastinitis Mitral valve stenosis Mononucleosis Multiple Sclerosis Mumps Myasthenia Gravis Myoneurogastrointestinal encephalopathy syndrome Neuroferritinopathy Opitz-Frias syndrome Oral cancer Oral submucous fibrosis Oral ulcers Oral candidiasis Palate cancer Palatoplegia Paracoccidioidomycosis Paraneoplastic syndrome Parkinson's Disease Peptic stenosis Peripheral neuropathy Pharyngitis Plummer-Vinson Syndrome Poliomyelitis Polyradiculitis Rabies Radiation esophagitis Reflux esophagitis Respiratory tract infections Retropharyngeal abscess Rheumatoid Arthritis Riedel thyroiditis Scarlet Fever Schatzki ring Scleroderma Stevens-Johnson Syndrome Stomatitis Supraglottic laryngeal cancer Syringobulbia Systemic Lupus Erythematosus Systemic sclerosis Tetanus Tonsillar abscess Tooth infection Typhoid fever Vagal disorder Xerostomia Zenker's Diverticulum

Symptoms to Differentiate Odynophagia From

• Dysphagia is defined as difficulty in swallowing

Diagnosis

History

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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