Odynophagia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Odynophagia is defined as painful swallowing. It is caused by various medical conditions. It should not be confused with dysphagia, which is difficulty in swallowing. Common causes of odynophagia are throat infections, foreign body, acid reflux disease, tumors, or injuries which may lead to difficulty in swallowing due to disturbing pain. Odynphagia is a word with Greek origin. There is no established system for the classification of odynophagia. However we can classify them according to causes to approach the area of involvement. The pain in swallowing is induced due to conditions causing stimulation of sensory nerves innervating esophagus and pharynx. Several diseases, such as, Achalasia cardia, Esophageal cancer, Myasthenia gravis, Scleroderma, Tonsillitis, upper respiratory tract infections, Zenkers diverticulum and gastroesophageal reflux disease have odynophagia as one of their presenting symptoms and thus, it is essential to differentiate these diseases from one another.

Odynophagia is a Greek word. (/oʊ-dɪnˈə-feɪˈjəˌ-jiː-ə/; from odyno- “pain” and phagō “to eat”) is pain when swallowing. Other than that there is no specific historical background of odynophagia.

There is no established system for the classification of odynophagia. However we can classify them according to causes to approach the area of involvement. Odynophagia may be classified according to causes into two groups which include disorders of esophagus and disorders of pharynx.

The pain in swallowing is induced due to conditions causing stimulation of sensory nerves innervating esophagus and pharynx. Infections of esophagus or pharynx cause fluid to leak into the interstitial media of mucous epithelium and it produce pressure on sensory nerve terminals situated in the mucosa. Tumors produce pain due to compression effect of mass on sensory nerve terminals situated in mucosa. Foreign body produce pain due to compression effect of foreign body on sensory nerve terminals situated in mucosa.

There are several diseases that present with odynophagia. Some of them include Achalasia cardia, Esophageal cancer, Myasthenia gravis, Scleroderma,Tonsillitis, Upper respiratory tract infections, Zenkers diverticulum and Gastroesophageal reflux disease.

The causes of odynophagia are of various pathologies. Differentiating them with adjacent history and examination is helpful to narrow down the exact pathology.

Common causes of odynophagia have their independent statistics. In 2015, In the USA, the prevalence of pharyngitis was 4.8 per 100,000 people with group A strep. The prevalence of GERD In the USA and Europe ranges from low of 10,000 per 100,000 persons to high of 20,000 per 100,000 people. In Asia, the prevalence of GERD is 5,000 per 100,000 people. The prevalence of esophagitis In the USA and Europe ranges from low of 10,000 per 100,000 persons to high of 20,000 per 100,000 people. In Asia, the prevalence of esophagitis is 5,000 per 100,000 people.

Risk factors depend on the individual risk factors of disease causing odynophagia.

The causes of odynophagia have their own independent course of progression and complication. However if disease is treated then pain is also relived to a certain degree depending on what the cause is.

Odynophagia is a symptom. History of patient presenting with painful swallowing will help in narrowing down the cause of odynophagia. The cornerstone of any dysphagia evaluation is a detailed history, and a thorough review of symptoms that can differentiate esophageal from oropharyngeal odynophagia and help predict the specific etiology of odynophagia. How a patient describes his or her difficulty and its timing, associated symptoms, and other characterizations may specifically denote the anatomic level of swallowing dysfunction.

Physical examination of patients with odynophagia is dependent on the underlying cause. Patients with odynophagia usually appear in discomfort. May be feverish and tachycardic in case of inflammation. May have exanthem in case of viremia or bacteremia. Neuromuscular examination of patients with odynophagia is usually normal. However in cases of URTI causing meningitis may produce symptoms of meningeal irritation.

Common tests which should be ordered in every case are CBC, ESR/CRP and some specific tests depending on the underlying etiology.

An electrocardiogram can be used to assess for left atrial enlargement or in viral infections also causing pericarditis. It may also be used to differentiate the cause of esophageal spasm.

The use of radiography of chest may help in differentiating multiple causes of odynophagia in the chest.

The benefit of using CT over X-ray is that it delineates the causative agent of odynophagia with more accuracy as compared to x-ray.

An MRI of the brain can be used to exclude CVA and mass lesions of the head and neck. It is more helpful in soft tissue margins which are causing pain in swallowing.

Echocardiography can be used to rule out cardiac causes of odynophagia.

The treatment of odynophagia depends on identifying and treating the underlying primary etiology. However some of the cases obtain benefit of using soothing agents as marshmallow plant, Sage and echinacea, apple cider vinegar, salt water gargle, honey, Licorice root, lemon water, ginger root tea, coconut oil, cinnamon, plenty of fluids, chicken soup, peppermint tea, chamomile tea and herbal throat lozenges.

Conditions causing pain on swallowing such as tumors, chronic inflammation inducing stricture, neuropathies not responding to medications or rings may need surgery to relive narrowing. As narrowing is resolved then food passage is smooth and pain is relived. Most of the conditions not responding to medication benefits with balloon dilation are treated surgically.

Odynophagia can be prevented primarily by avoiding the conditions causing it. Earlier diagnosis of tumors and treatment of conditions causing inflammation of upper respiratory tract or upper GI tract will reduce the chances of development of odynophgia.

The conditions causing odynophaiga are treatable. Once the pathology causing odynophaiga are treated then pain on swallowing also improves. However soothing agents help in faster recovery when primary cause is addressed.

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Odynophagia is a Greek word. (/oʊ-dɪnˈə-feɪˈjəˌ-jiː-ə/; from odyno- “pain” and phagō “to eat”) which means pain when swallowing. Other than that there is no specific historical background of odynophagia.

Odynophagia is a Greek word. (/oʊ-dɪnˈə-feɪˈjəˌ-jiː-ə/; from odyno- “pain” and phagō “to eat”) which means pain when swallowing. Other than that there is no specific historical background of odynophagia.

Template:WH Template:WS.“Odynophagia | Define Odynophagia at Dictionary.com”.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Odynophagia pathophysiology is related to causes.

Odynophagia pathophysiology is related to causes. The following are common mechanisms involved in inducing pain in esophagus and pharynx

• Pharynx is partitioned as the nasopharynx, the oropharynx and the laryngopharynx. Odynophagia is outcome of pain sensed in orophyranx and laryngopharynx.^[1]
• The oropharynx starts from the uvula ends at hyoid bone. Anteriorly, through isthmus faucium,opens into the mouth, latterly it has the palatine tonsil. 
• It is lined with non-keratinised squamous stratified epithelium.^[2]
• The laryngopharynx aka hypopharynx, is on rare end.
• Internal laryngeal branch of the superior laryngeal nerve, innervate larynx up to vocal folds. The recurrent laryngeal nerve innervate larynx inferoirly..^[3]
• Vagus nerve supply all the muscles of the pharynx and soft palate except the two muscles.
• Stylopharyngeus receives innervation from cranial nerve IX.
• Tensor veli palatini receives innervation from cranial nerve V.
• The glossopharyngeal nerve receives sensory input from greater portion of all three parts of the pharynx. ^[4]
• The Pharyngeal plexus is motor and sensory center of larynx.
• Pharyngeal plexus consist of nerves from vagus and glossopharyngeal nerves and also by sympathetic nerve fibers.
• The esophagus has dual sensory innervation, from parasympathetic and sympathetic, which depends on location of level independently .^[5]

Infection of esophagus or pharynx causes fluid leaking in interstitial media of mucous epithelium and it produce pressure on sensory nerve terminals situated in mucosa.^[6]

It produces pain due to compression effect of mass on sensory nerve terminals situated in mucosa.^[7]

It produce pain due to compression effect of foreign body on sensory nerve terminals situated in mucosa.^[8]

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

The causes of odynophagia are disorders effecting sensory nerves of esophagus and pharynx.

Following are the causes of odynophagia.^{[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]}

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

Following are less common causes divided on basis of anatomical level of location.

1. Mechanical causes:

Following is the list of disorders which cause pain on swallowing due to mass effect or pressure on esophagus while food passes through it:

• Achalasia cardia
• Esophageal cancer
• Myasthenia gravis
• Botulism
•  Goiter
• Diabetic neuropathy
• Hyperthyroidism
• Hypothyroidism
• Riedel thyroiditis
•  Barrett’s oesophagus
• Diverticulum
• Esophageal achalasia
• Esophageal atresia
• Esophageal spasm
• Esophageal stricture
• Fibrosis
• Intramural pseudodiverticulosis
• Peptic stenosis
• Schatzki ring
• Myoneurogastrointestinal encephalopathy syndrome
• Amyotrophic Lateral Sclerosis (ALS)
• Brainstem stroke
• Bulbar palsy
• Central vagal nucleus lesion
• Cerebrovascular accident
• Guillain-Barre syndrome
• Huntington’s chorea
• Multiple Sclerosis
• Neuroferritinopathy
• Peripheral neuropathy
• Polyradiculitis
• Syringobulbia
• Vagal disorder
• Diabetic neuropathy
• Poliomyelitis
• Plummer-Vinson Syndrome
• Bronchial carcinoma
• Carcinoma of the vocal tract
• Carotid body tumor
• Esophageal cancer
• Gastric tumors
• Laryngeal cancer
• Leiomyoma
• Bronchial carcinoma
• Esophageal trauma
• Aspiration of foreign body

2. Inflammatory causes:

Following is the list of disorders which cause pain on swallowing due to irritation of nerves because of inflamed mucosa of esophagus while food passes through it:

• Chemical burns
• Ibandronate
• Stevens-Johnson Syndrome
•  Esophagitis
• Gastritis
• Gastroesophageal reflux
• Crohn’s disease
• Eosinophilic esophagitis
• Radiation esophagitis
• Abscesses
• Candidiasis
• Chagas Disease
• Cytomegalovirus
• Esophageal moniliasis
• HIV/AIDS,
• Reflux esophagitis
• Typhoid fever
• Allergic swelling
• Behcet’s Syndrome
• CREST syndrome
• Dermatomyositis
• Esophageal sarcoidosis
• Inclusion body myositis
• Rheumatoid Arthritis
• Systemic Lupus Erythematosus
• Xerostomia
• Alcoholism

1. Mechanical causes:

Following is the list of disorders which cause pain on swallowing due to mass effect or pressure on phyarynx while food passes through it:

• Zenkers diverticulum
• Cricopharyngeal spasm
• Oral submucous fibrosis
• Palatoplegia
• Palate cancer
• Supraglottic laryngeal cancer
• Xerostomia
• Agranulocytosis
• Lymphadenopathy
• Elongated styloid process
• Extreme spinal curvature
• Global hystericus
• Schatzki ring
• 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
• Vagal disorder
• Diabetic neuropathy
• Bronchial carcinoma
• Carcinoma of the vocal tract
• Hypopharyngeal cancer
• Laryngeal cancer
• Leiomyoma
• Oral cancer
• Palate cancer
• Supraglottic laryngeal cancer

2.Inflammatory causes:

Following is the list of disorders which cause pain on swallowing due to irritation of nerves because of inflamed mucosa of phyranx while food passes through it:

• Pharyngitis
• Tonsillitis
• Laryngitis
•  Epiglottitis
• Glossitis
•  Retropharyngeal absces
• Acute pharyngitis
• Adenoiditis
• Angina tonsillaris
• Diphtheria
• Herpangina
• Herpes simplex virus (HSV)
• Herpes stomatitis
• Mononucleosis
• Mumps
• Oral candidiasis
• Paracoccidioidomycosis
• Poliomyelitis
• Scarlet Fever
• Tonsillar abscess
• Tooth infection

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Odynophagia should be differentiated from dysphagia (difficulty in swallowing). There are many causes of odynophagia. They can also be differentiated with help of appropriate H & E and diagnostic procedures.^{[1][2][3][4][5]}

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Common causes of odynophagia have their independent statistics.

Following are statistics of common causes of odynophagia :

• In 2015, In the USA, the prevalence of Pharyngitis was 4.8 per 100,000 people with group A strep.

• In the USA, the incidence of URTI is 5,400 per 100,000 persons.

• URTI affects mostly extremes of age groups.

• In the USA and Europe, the prevalence of GERD ranges from low of 10,000 per 100,000 persons to high of 20,000 per 100,000 people. [1]
• In Asia, the prevalence of GERD is 5,000 per 100,000 people.

• In the USA, the incidence of GERD is 5,400 per 100,000 persons.^[1][2][3]
• In Europe, the incidence of GERD is 840 per 100,000 persons.

• The prevalence of GERD increases with age.
• GERD affects all age groups but it affects more the people older than 40 years.

• Men and women are affected equally by GERD.

• There is no racial predilection for GERD.

• In the USA and Europe, the prevalence of esophagitis ranges from low of 10,000 per 100,000 persons to high of 20,000 per 100,000 people.^{[4][5][6][7][8][9][10]}
• In Asia, the prevalence of esophagitis is 5,000 per 100,000 people.
• The prevalence of esophagitis is approximately 50-100 per 100,000 individuals worldwide.

• In the USA, the incidence of esophagitis is 5,400 per 100,000 persons.
• In Europe, the incidence of esophagitis is 840 per 100,000 persons.
• The incidence of esophagitis is approximately 10 per 100,000 individuals worldwide.

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

There are no established risk factors for odynophagia. However individual conditions which produce pain on swallowing may have independent risk factors.

There are no established risk factors for odynophagia. However individual conditions which produce pain on swallowing may have independent risk factors.^{[1][2][3][4][5][6][7][8][9][10][11][12]}

• Smoking
• Extremes of age
• Cold
• Low immunity
• Malnutrition
• Allergy
• Lack of immunization

• Smoking
• Betel nuts
• Age over 60
• Male gender
• Alcohol consumption
• Obesity
• Lye Ingestion
• Nitrosamine in food
• Gastroesophageal reflux disorder
• Barrett’s esophagus
• Achalasia
• EBV
• HIV
• Radiation

• Young age
• Neuropathy
• Decreased consciousness

• Smoking
• Obesity
• Pregnancy
• Hiatal hernia
• Scleroderma
• Drinking a lot of alcohol
• Consuming drinks that contain caffeine
• Anticholinergics (e.g. for sea sickness)
• Beta blockers for high blood pressure or heart disease
• Bronchodilators for asthma
• Calcium channel blockers for high blood pressure
• Dopamine active drugs for Parkinson’s disease
• Progestin for abnormal menstrual bleeding or birth control
• Sedatives for insomnia or anxiety
• Tricyclic antidepressants

• Smoking
• Obesity
• Pregnancy
• Hiatal hernia
• Scleroderma
• Alcohol consumption
• Consuming drinks that contain caffeine
• Anticholinergics (e.g. for sea sickness)
• Beta blockers for high blood pressure or heart disease
• Bronchodilators for asthma
• Calcium channel blockers for high blood pressure
• Dopamine-active drugs for Parkinson’s disease
• Progestin for abnormal menstrual bleeding or birth control
• Sedatives for insomnia or anxiety
• Tricyclic antidepressants

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

If left untreated, patients with odynophagia may progress to develop weight loss, malnutrition, and food aversion. Prognosis is generally excellent, and the mortality/survival rate of patients with odynophagia depend on the primary cause.

• If left untreated, patients with odynophagia may progress to develop weight loss, malnutrition, and food aversion.
• However the causes of odynophagia have their own independent course of progression and complication. 

• Common complications of odynophagia depend on the treatment and progress of primary disease, which may include:
  • URTI: LRTI, toxemia, meningitis, pneumonia, otitis, orbital infections, systemic infections, encephalitis.
  • GERD: Stricture,weight loss, Barrett’s esophagus, erosive esophagitis, esophageal ulcer, esophageal adenocarcinoma.
  • Tumor: Metastasis, narrowing of food passage, weight loss, DVT.
  • Foreign body: local inflammation, non invasive and invasive infections.
  • Esophagitis: Weight loss, superimposed bacterial infections, stricture.

• Prognosis is generally excellent, and the mortality/survival rate of patients with odynophagia depend on the primary cause.
  • Tumors: Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. Adenocarcinoma has better prognosis compared to squamous cell cancers.
  • URTI: Prognosis is generally excellent. Viral URTI’s have better outcomes compared to bacterial URTI’s.
  • GERD: Prognosis is generally good. If untreated 20% may develop esophageal strictures.^[1]
  • Foreign body: Prognosis is generally excellent, if foreign body is removed in a timely manner.
  • Esophagitis: Prognosis is generally good. It depends mostly on the cause of esophageal inflammation. Viral infections recover earlier with less complications compared to autoimmune, bacterial and chemical causes.

Template:WH Template:WS