Odynophagia

What is Odynophagia?

Odynophagia can be described as the pain that appears when a person tries to swallow. The pain can be present at the different levels of the gastrointestinal tract, starting with the mouth and continuing at the level of the pharynx or esophagus. It is possible that this pain is connected to the pathologies of the surrounding elements, such as the pharynx. Odynophagia can appear as the patient swallows saliva automatically or when he/she tries to swallow food or beverages. It can be accompanied by other symptoms, such as pain at the level of the chest. Identifying the underlying cause behind the appearance of odynophagia is essential, so as to be able to provide the right treatment.

Signs and Symptoms of Odynophagia

These are the signs and symptoms that can accompany odynophagia:

• Dysphagia (difficult swallowing)
• Stomatodynia (pain at the level of the mouth)
• Pain during mastication
• Regurgitation (reflux pharyngitis)
• In some cases, the pain can be replaced by mild discomfort
• It is possible that the pain eases throughout the day
• Persistent sore throat
• Dyspnea (difficult breathing)
• Dysphonia (hoarse or whispering voice) – together with the dyspnea, can be suggestive of larynx or tracheal pathology
• Unintentional weight loss
• Burning sensation
• Pain radiates to other places in the body, such as the back.

Causes of Pain during Swallowing

These are the main causes that can lead to the appearance of odynophagia:

Infection

• Most common:
  • Stomatitis (infection of the oral mucosa)
  • Tonsillopharyngitis (infection at the level of the tonsils and pharynx)
  • Epiglottitis (infection at the level of the epiglottis)
  • Esophagitis (infection at the level of the esophagus)
• Microorganisms responsible for the infection:
  • Herpes simplex virus
  • Epstein-Barr virus
  • Cytomegalovirus
  • HIV
  • Candida albicans.

Foreign body

• The foreign body can remain stuck in the throat or at the level of the esophagus
• Complete or partial obstruction
• If the obstruction is at the level of the larynx, the breathing might be impaired (requiring emergency medical assistance)
• Apart from leading to difficult swallowing, the foreign body can also cause damage upon the surrounding tissues (for example, a fish bone can pierce the lining of the throat or cause damage to the tonsils or the esophagus)

Inflammation (accompanied by sores or ulceration)

• Trauma or physical injury
• Diagnostic investigation (such as endoscopy)
• Eating/drinking foods/beverages that are either too hot or spicy
• Ingestion of harmful substances (caustic effect)
• Autoimmune disorders
• Radiation
• Gastroesophageal reflux
• Inhalation of harmful substances (such as toxic gas).

Neoplastic growth

• Areas in which the cancer can appear: mouth, esophagus, pharynx, larynx, trachea, thyroid gland, throat
• Risk factor – chronic smoking
• Red signal – excessive weight loss (unintentional)
• Primary/secondary neoplastic growth (metastases)
• Odynophagia almost always accompanied by dysphagia.

Disorders of the esophagus

• Esophageal motility disorder (achalasia)
• Spams at the level of the esophagus (also known as the nutcracker syndrome)
• Perforation or tear at the level of the esophagus
• Ulcer or webbing in the esophagus lining; diverticulum.

Diagnosis of Odynophagia

These are the main methods used in order to identify the condition behind odynophagia:

• Medical history of the patient
  • When did he/she notice the symptoms for the first time
  • Pre-existing conditions
  • Medical treatments and surgical interventions
  • Diet habits
  • Smoking/alcohol intake
• Physical examination
  • Analysis of the oral mucosa
  • Health of the tongue
  • Weight measurement (compared to recent measurements – can be useful in identifying unintentional weight loss, sign of cancer)
• Imaging studies
  • Endoscopy – analysis of the gastrointestinal tract, identification of esophageal pathology
  • Radiography – the patient might require to drink barium, the contrast guaranteeing a better visualization of the GI tract
  • pH manometry studies – recommended in the situation that the endoscopy does not provide the desired information
  • MRI or CT scan – indicated in more severe cases, being necessary for the confirmation of the diagnosis.

Odynophagia Treatment

The treatment of odynophagia is clearly dependent on the underlying cause. In the majority of the cases, once the underlying cause has been addressed, odynophagia will disappear on its own.

These are the most common measures of treatment recommended for those suffering from odynophagia:

• In case of infection:
  • Antibiotics
    • Recommended for bacterial infection
    • The treatment should be taken for as long as it is prescribed, otherwise the bacteria will develop resistance to the treatment
    • Probiotic supplements are administered concomitantly with the antibiotic treatment, so as to maintain a healthy intestinal flora
  • Antiviral medication
    • Recommended for viral infections
    • Retroviral medication for HIV/AIDS patients
  • Antifungal medication
    • Recommended for fungal infections.
  • Antibacterial mouthwash – can be recommended as treatment or as preventative measure.
• Surgical intervention
  • Removal of foreign body
  • Reparation of the damaged tissue (if any)
• Stomach pumping
  • The pumping of the stomach contents is recommended in the situation that the person has ingested substances that are toxic
• Supportive care
  • Recommended in case of accidental ingestion or intoxication with harmful gases
  • Ventilation (oxygen therapy) and administration of intravenous fluids
• In case of cancer:
  • Chemotherapy
  • Radiation therapy
  • Removal of neoplastic growth and replacement with healthy tissue (if possible)
• In case of esophageal disorders:
  • Antacids
  • Other medication
  • Surgical intervention.

In conclusion, it is important to remember that odynophagia is not a condition on its own but rather a symptom. So, before you start looking for remedies to improve the difficult swallowing, you need to visit the doctor and obtain the correct diagnosis. Only after the diagnosis regarding the underlying condition has been made, should you consider the treatment. As you might have seen in this article, it is possible to prevent the difficult swallowing by changing some of your habits. The diet can be often times one of the biggest problems but eliminating certain foods from your life should be more than enough. You may also want to maintain an excellent dental hygiene, as the bacteria from the mouth can reach the other surrounding structures, leading to associated infections. In case of foreign bodies, you need to pay attention to the foods you are eating, especially certain types of fish.