Odynophagia: Symptoms, causes, diagnosis and treatment

Odynophagia: Symptoms, causes, diagnosis and treatment

What is odynophagia?

Odynophagia refers to painful swallowing. The pain is often felt in your throat, oesophagus and sometimes even in your mouth. One may experience painful swallowing with either liquids or solids or even both. Many of us have experienced painful swallowing in one point of our life, particularly following a bad cold or cough. However, this pain is only temporary and disappears as you get over with the cold or cough. Unfortunately, painful swallowing can persist for some of us even after you get over the cold or cough.

What exactly does a patient with odynophagia feel? In most people who experience odynophagia, they feel a very uncomfortable burning sensation in their mouth or throat every time they try to swallow. Other symptoms of odynophagia may include:

  • Feeling of tightening nature around the neck every time you try to swallow, may it be liquids or solids. This feeling can also be experienced when you are just trying to clear the throat.
  • Sometimes you may also experience a stabbing pain which radiates towards the back.
Medical Definition of Odynophagia
What can cause difficulty in swallowing?

What are the causes of painful swallowing?

The causes of painful swallowing can vary from following ingestion of hot and spicy foods to more dangerous disease conditions. Painful swallowing can also result from minor conditions such as the common cold. Causes like this will resolve spontaneously over time. The most common causes of painful swallowing are:

  1. Infection

Infection is the most common cause of odynophagia. This could be a simple infection of the tonsils or a severe infection such as HIV infection or Herpes infection. People with AIDS often develop problems with their oesophagus. The most common cause of odynophagia in patients diagnosed with AIDS is candida infections.

  1. Candida infection

Candida is a type of fungal infection that commonly occurs in the mouth. This is known as oral candidiasis. Candidiasis infections can also spread and lead to symptoms arising from the oesophagus such as painful swallowing.

  1. Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease results when the lower sphincter of the oesophagus is not working properly. A normally functioning lower oesophageal sphincter would be closed at all times except when there is food bolus. However, in Gastroesophageal reflux disease, this sphincter does not close properly. Therefore, acid from the stomach will enter the oesophagus. This can also be a contributing factor for your painful swallowing. This could also be associated with other symptoms such as heart burn and chest pain.

  1. Cancer

Cancer of the oesophagus manifests as chronic difficulty in swallowing and sometimes with painful swallowing. Therefore oesophageal cancer is an important diagnosis that should be excluded in all patients with difficulty in swallowing as well as painful swallowing. Some of the common causes of oesophageal cancer include chronic smoking, alcohol abuse and gastro-oesophageal reflux disease.

  1. Ulcers in the mouth, throat or oesophagus

Ulcers in the mouth, throat or oesophagus can also result in painful swallowing. One can develop ulcers in these areas following untreated gastro oesophageal reflux disease. The risk of ulcers is also increased with the use of drugs such as non-steroidal anti-inflammatory drugs like Ibuprofen for a long period of time.

  1. Foreign body

The presence of a foreign body stuck somewhere in your throat or oesophagus can also cause painful swallowing, particularly with the presence of something small and sharp. Not just pain during swallowing, it can also cause you difficulty in swallowing.  Obstruction with a fish bone is one of the most common encounters.

  1. Radiation therapy

Patients undergoing radiation therapy for cancer may also develop odynophagia.

Causes of painful swallowing can be classified into conditions associated with throat pain and conditions associated with chest pain.

The conditions associated with throat pain during swallowing include:

  1. Foreign body lodged in the throat such as a seed or fish bone.
  2. Cancer of the throat
  3. Laryngopharyngeal reflux
  4. Oral candidiasis
  5. Streptococcal infection of the throat
  6. Viral infection of the throat such as Herpes and HIV
  7. Injury to the throat

The conditions associated with chest pain during swallowing include:

  1. Oesophageal ulcers that may result from acid reflux, candida infection or Herpes infection, Crohn’s disease, and radiation therapy.
  2. Spasms of the oesophageal muscle
  3. Cancer of the oesophagus
  4. Mallory Weiss tears of the oesophagus – This is the tearing of the oesophageal wall following repeated bouts of vomiting.

Chest pain during swallowing: Is it a symptom of heart disease?

The development of chest pain during swallowing is most likely to be a problem in the oesophagus such as food impaction in the oesophagus, gastro oesophageal reflux disease, infection of the oesophagus or oesophageal spasms. However, it is important to keep in mind that coronary heart disease can also be precipitated following a large meal. Therefore, if you ever experience a chest pain, even with swallowing, it is best to get it checked.

What is oesophagitis?

Oesophagitis refers to the inflammation of the oesophagus. It can be due to a viral, bacterial or a fungal cause. The incidence of oesophageal infections have increased with the increase in the number of patients with immunocompromised states.

Often, infections of the oesophagus presents with acute onset difficulty in swallowing (acute dysphagia), painful swallowing (odynophagia) and chest pain. Patients, who experience severe ulceration of the oesophageal mucosa, may also experience bleeding from the oesophagus. This is, however, self-limiting and small in quantity. But there are instances where life threatening haemorrhage can occur.

Viral oesophagitis

The most common causes of viral oesophagitis in an immunocompromised patient is Herpes simplex virus (HSV) type 1 or 2. These patients may experience systemic manifestations such as nausea, vomiting and fever. Endoscopy is useful in diagnosis of herpes simplex oesophagitis as small vesicles in the oesophageal mucosa can be visualized. These vesicles may proceed to confluent ulcers and diffuse erosive oesophagitis. These lesions can also get superinfected with bacteria or fungi.

Another common cause of viral oesophagitis, especially in children is Varicella Zoster virus infection. The oesophageal lesions are similar to those of HSV.

Cytomegalovirus infection occurs in immunocompromised hosts. Serpiginous ulcers can be visualised in the oesophagus via an endoscopy. These ulcers are large and deep with a normal mucosa surrounding it. These ulcers too can coalesce to form larger lesions. Ganciciclovir is the treatment of choice and should be continued from a few weeks to months for complete healing of ulcers.

Bacterial oesophagitis

Bacterial oesophagitis is very rare. However, patients infected with HIV may develop bacterial infections of the oesophagus due to Cryptosporidium or P.carinii.

Fungal oesophagitis

Candida infection of the oesophagus is not usually seen in normal, healthy individuals. This sort of infection is common in patients with immunodeficiency disorders such as diabetes mellitus, chronic renal failure, and AIDS. Other candidates that can develop this infection include those who are under treatment with long term corticosteroids, immunosuppressive chemotherapy and those with achalasia cardia or scleroderma.

esophageal candidiasis symptoms adults
Is esophageal candidiasis contagious?

Normal, healthy individuals carry candida organisms in their oral flora as a non-pathogenic organism. Most patients with oesophageal candidiasis may be asymptomatic or may have pain during swallowing and difficulty in swallowing.

How does oral thrush develop?

Everyone has candida growing inside their body but not everyone develops thrush. Why is this? This is because in all healthy individuals, candida is kept in balance by the body’s immune system. It is when this balance is interrupted; one develops thrush due to the overgrowth of Candida.

This overgrowth can be triggered during:

  • Illnesses that weaken your immune system
  • Pregnancy
  • Medications that suppress the immune system such as corticosteroids and anti-cancer drugs.

It is quite common to see most new-borns and infants develop candidiasis but unless it causes poor feeding or a loss of weight it should not be a concern.

Oral candidiasis can be diagnosed by visualizing the white flake appearance in the throat. Endoscopy may also reveal raised white pseudomembranous plaques with redness of the associated mucosa.

Healthy individuals can be easily treated with anti-fungal medications to treat oral thrush but treatment will be difficult in those with a weakened immune system. Anti-fungal medications come in several forms including tablets, lozenges or liquids and they are supposed to be taken for a period of 10 to 14 days.

The drug that will be prescribed to you will be decided by your physician depending on your age and the cause of infection.

Since oral thrush can be the result of several other medical conditions, your physician may ask you to run out further tests to exclude these possibilities. If such medical problem is detected, then treatment for it will be started.

Apart from the anti-fungal medication, other measures like controlling of your diabetes, and stopping smoking should also be carried out to gain complete cure. However, infants and toddlers do not require any treatment unless it has been persisting for several weeks, reduced feeding or the baby has lost weight. If such circumstances develop, take your child to a pediatrician as early as possible. They may start an anti-fungal such as Nystatin to cure the infection.

What is the difference between dysphagia and odynophagia?

Dysphagia vs Odynophagia
Dysphagia vs Odynophagia

Odynophagia and dysphagia are two common words which are often confused with each other. Although both these words refer to conditions involved with swallowing, they have two different meanings. Dysphagia refers to difficulty in swallowing. Dysphagia, just like odynophagia, can be caused by a variety of conditions. The exact treatment of dysphagia will therefore depend on the underlying condition. Dysphagia may be only for liquids, only for solids or both liquids and solids.

Dysphagia and odynophagia can occur concurrently. Therefore both these conditions can have the same underlying cause. However, there are times that you may only experience difficulty in swallowing without pain in swallowing while on the other hand, there are times that you may only feel pain in swallowing and not have difficulty to swallow.

How is odynophagia diagnosed?

Diagnosing any health condition requires three main components. They are a detailed history, complete physical examination and investigations.

At your first visit to your doctor, he or she will first take a detailed history from your regarding your presenting complaint. They may ask questions like:

  • How long have you been experiencing pain on swallowing?
  • Was it of sudden onset or gradual onset?
  • Do you have difficulty in swallowing as well?
  • Do you have any other symptoms other than painful swallowing?
  • Where exactly do you feel the pain?

After taking a complete history, your health care provider will then move on to do a full physical examination on you. Physical examination will also give good signs that may give the doctor an indication of the most likely underlying cause. For example, your doctor will palpate your abdomen and find out epigastric tenderness and this may give a clue that you may be having gastro oesophageal reflux disease.  Knowing this will help them to order the necessary investigations and to make an early diagnosis.

Next, he or she may order certain investigations for them to confirm their diagnosis. Odynophagia is typically diagnosed following endoscopy. An endoscopy is carried out by a gastroenterologist. A long flexible tube with a camera attached to it at the end will be inserted through your mouth. You will be given sedatives before this procedure to make it less painful. However, it will be a little uncomfortable. With this, your doctor will be able to visualize the inside of your esophagus and inspect the lining epithelium. If your health care provider suspects that the painful swallowing is due to a esophageal cancer, then he or she will take a biopsy from the esophageal lining during the endoscopy procedure. This biopsy sample will then be sent for histology to confirm the diagnosis.

In addition to endoscopy, your health care provider may order additional tests such as blood tests that are related to the suspected underlying causes of odynophagia. However, it is important to know that although you are experiencing pain during swallowing, these blood tests can turn out normal.

 How is odynophagia treated?

The treatment of odynophagia depends on the underlying cause. Once the underlying cause is treated, the complaints of painful swallowing will also be lost. If no underlying condition is found, then the painful swallowing will resolve on its own over time. This is especially true for people developing painful swallowing following a common cold or severe allergic reactions. In such cases, your doctor may give some medication to reduce your symptoms.

Treatment of odynophagia can be medical or surgical.

Medical treatment

The treatment, as said earlier will depend on the underlying cause. For instance, if the underlying cause for your painful swallowing is gastro oesophageal reflux disease, then treatment with drugs which are used to treat GERD will help to improve your symptoms.

If the underlying cause is due to a candida infection, then treatment with anti-fungal therapy is necessary. Likewise, if the underlying cause is HIV or other infections, specific treatment is necessary to overcome those infections.

Surgical treatment

Surgical treatment is considered in patients who are diagnosed to have a tumour in the oesophagus. In such cases, the tumour is removed surgically. Sometimes surgery alone is not sufficient to entirely get rid of the tumour. Radiation and chemotherapy may also be necessary. Radiation and chemotherapy will help to reduce the size of the tumour and also helps to prevent the cancer cells from spreading throughout the body.

If the underlying cause is caught early and treatment is started as soon as possible, the health condition can improve. If you do not get the underlying cause treated, odynophagia and the underlying cause can lead to many other complications. Because of the pain experienced during swallowing, you may refuse to eat much and this can eventually lead to weight loss and other health concerns such as malnutrition, anaemia and dehydration.

What home remedies are available to help painful swallowing?

The following simple measures can be taken to prevent the pain associated with swallowing:

  1. Have small meals and every time you eat, chew the food well and eat slowly.
  2. Stay away from rough, dry and very spicy foods. It is also better to avoid very hot or very cold foods.

If you develop severe pain during swallowing, this could be due to food being stuck in your throat. If that is the case, you can try the following home remedies to relieve the pain you experience.

  1. Valsalva manoeuvre – While pinching the nose with your fingers, try to blow air through it.
  2. Drink warm or hot water to relieve the pain caused by diffuse oesophageal spasms or achalasia. Carbonated drinks may also help to relieve the chest pain caused by these conditions

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Thilini Gunawardane
About Thilini Gunawardane 28 Articles
I am a final year medical student and I'm currently doing my clinical rotations in a private hospital. A huge people-person, an open minded who spent several years in the field of Medicine. I am at my final year on Medicine and clinical rotations at a Hospital (Dr Neville Fernando Teaching Hospital (NFTH). My long term run is to be a consultant one day and serve everyone in need. This has always been in my bucket list and I myself as a go-getter, will make my promisses and prove it to my self. Every-day I wake up knowing how little I know and I work for it. I learn, I use all my sources I have. Working online, I have gained so much experience and learned many things that a person should have in a working environment, time/project management, satisfying the client, meeting deadlines on time.

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