Odynophagia: Painful Deglutition

Odynophagia refers to discomfort or pain experienced during the act of swallowing. This sensation can arise from various underlying causes affecting the mouth, pharynx (throat), or esophagus.

Potential Etiologies

• Infectious Agents: Viral, bacterial, or fungal infections, such as pharyngitis (strep throat), tonsillitis, epiglottitis, infectious mononucleosis, herpes simplex virus (HSV), and candidiasis (thrush).
• Inflammatory Conditions: Esophagitis due to gastroesophageal reflux disease (GERD), eosinophilic esophagitis, or medication-induced esophagitis.
• Structural Abnormalities: Esophageal strictures (narrowing), webs, rings (e.g., Schatzki ring), tumors (benign or malignant), or foreign body obstruction.
• Musculoskeletal Issues: Muscle spasms or dysfunction in the throat or esophagus.
• Neurological Disorders: Conditions affecting the nerves that control swallowing, such as stroke or neurological diseases.
• Medications: Certain medications, including NSAIDs, antibiotics, and bisphosphonates, can cause esophageal irritation.
• Radiation Therapy: Radiation to the head or neck can cause mucositis and difficulty with swallowing.
• Dryness: Insufficient saliva production, often related to dehydration or certain medical conditions (e.g., Sjogren's syndrome).

Associated Symptoms

Odynophagia can be accompanied by various symptoms depending on the underlying cause, including:

• Sore throat
• Hoarseness
• Cough
• Dysphagia (difficulty swallowing)
• Heartburn
• Regurgitation
• Weight loss
• Fever
• Swollen lymph nodes

Diagnostic Evaluation

Determining the etiology typically involves a comprehensive evaluation, which may include:

• Medical History and Physical Examination: Review of symptoms, medical history, and a thorough physical exam.
• Endoscopy: Visualization of the esophagus and stomach with a flexible endoscope (esophagogastroduodenoscopy or EGD).
• Barium Swallow Study: An X-ray that visualizes the esophagus during swallowing.
• Esophageal Manometry: Measures the pressure and function of the esophagus muscles.
• pH Monitoring: Measures the amount of acid in the esophagus.
• Biopsy: Tissue samples may be taken during endoscopy for microscopic examination.
• Blood Tests: May be performed to assess for infection or other underlying conditions.

Management Strategies

Management focuses on addressing the underlying cause of the condition.

• Infections: Antibiotics for bacterial infections, antifungals for fungal infections, and antiviral medications for viral infections.
• Esophagitis: Proton pump inhibitors (PPIs) to reduce stomach acid, dietary modifications, and avoidance of triggering foods.
• Structural Abnormalities: Dilation (stretching) of esophageal strictures, removal of foreign bodies.
• Pain Management: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide temporary relief. Topical anesthetics may also be used for oral or pharyngeal pain.
• Dietary Modifications: Consuming soft, bland foods and avoiding hot, spicy, or acidic foods can help minimize irritation.