Odynophagia

Do you experience a piercing pain in the chest while having your meals? Watch out, for you may be having a neuromuscular disease known as Odynophagia. Read and find out all about this condition, including its causes, symptoms, diagnosis, and treatment procedures.

Odynophagia Definition

It is a condition marked by acute pain on swallowing solid foods and fluids. It is often accompanied by Dysphagia – a disorder characterized by difficulties or discomforts in swallowing. Odynophagia is usually more pronounced in individuals with a serious of esophageal disorders and is often misinterpreted by the patients as “Angina pectoris”.

Odynophagia Symptoms

Individuals affected by this condition do not experience any problem in the process of swallowing. There is no delay in the passing of food through the esophagus. However, a piercing chest pain occurs when the food stays in the esophagus for a while before entering the stomach. The site of pain is normally below the sternal bone or breast bone, which often radiates to the back. It initially begins as a mild throat or neck pain that is often mistaken to be a common symptom of flu or cold. Swallowing foods or liquids further exacerbates the pain. Affected patients usually describe this swallowing disorder as a sharp ache, caustic pain, or penetrating pain. Many sufferers experience a squeezing sensation around the throat while attempting to swallow. As the condition gets more severe, swallowing one’s own saliva becomes extremely painful. The symptoms tend to decrease as the food leaves the esophagus to enter the stomach. Such patients develop loss of appetite that gradually leads to drastic weight loss.

Odynophagia Causes

The process of swallowing is a complex neuromuscular activity. The food is chewed and passed into the pharynx. The muscular contraction of the pharynx pushes the food into the esophagus that finally reaches the stomach to undergo digestion. Swallowing disorders usually occur when the pharynx or esophagus begins to malfunction. Severe inflammation of the esophagus, medically termed as Esophagitis can be linked to this painful condition. The mucosal lining of the esophagus could either be damaged or irritated due to the following reasons:

Esophageal motility disorders

The movement of food through the esophagus by a series of muscle contractions called peristalsis may often become irregular, unsynchronized or absent, causing motility disorders. Achalasia is a rare disorder of the muscle of the esophagus. In this condition, the lower esophageal sphincter fails to open and allow the food to pass into the stomach, causing difficulty as well as discomfort in swallowing. The other disorders include:

  • Diffuse esophageal spasm
  • Nutcracker esophagus
  • Hypertensive esophageal sphincter

Gastroesophageal reflux disease (GERD)

In this gastrointestinal disorder, the acidified liquid content of the stomach regurgitates into the esophagus. The constant episodes of heartburn, nausea and acid reflux slowly damages the esophageal lining, causing acute inflammation.

Infections

A host of bacteria, viruses, or fungi can cause infection and inflammation of the esophagus. Individuals in immunocompromised states are more susceptible to these infections and may suffer from esophagitis. These causative agents include:

Candida albicans

It is a fungus that overgrows in the esophagus, causing Esophageal candidiasis, that result in painful swallowing.

Herpes simplex virus (HSV)

The resulting viral infection leads to formation of large esophageal lesions that causes sharp pain while swallowing food.

Cytomegalovirus (CMV)

The viral agent can cause infections of the gastrointestinal tract in individuals with weakened immune system. The infection can give rise to multiple discrete lesions that are normally visible at the end of esophagus.

Upper respiratory tract infections caused by viruses such as parainfluenza virus, rhinovirus, and respiratory syncytial virus may lead to inflammation of the nose, pharynx or larynx. However, the viral agents can migrate to the esophagus, causing acute inflammation followed by painful swallowing.

Autoimmune disorder

Eosinophilic esophagitis is an allergic condition that is characterized by inflammation of the esophagus due to the presence of numerous white blood cells called eosinophils. It gives rise to a number of symptoms, including painful swallowing.

Cancer

Esophageal cancer is caused by long-term irritation of the esophagus such as Barrett’s esophagitis and is highly detrimental to the health of the patients. Carcinoma of the lower and upper esophagus can cause difficulty and pain on swallowing solid food.

Ulcers

Esophageal ulcers are open sores or lesions in the lining of the esophagus that causes intolerable pain below the breastbone. Corrosion of the esophageal lining due to acid reflux can make the process of swallowing quite painful and bothersome.

Irritants

Smoking, alcohol intake, and prolonged use of anti-inflammatory drugs can irritate the esophageal lining, owing to increased stomach acid production, and cause acid reflux.

Epiglottitis

It is a serious condition marked by acute infection and inflammation of the epiglottis- a flap of tissue situated at the base of the tongue that obstructs food from entering the trachea or windpipe during swallowing. Infectious, chemical, and traumatic agents responsible for causing this condition may even infect the esophagus and prevent its normal functioning.

Consumption of foods exposed to extreme temperatures

Regular intake of very hot or cold foods as well as beverages can trigger inflammation of the esophageal lining, resulting in acute pain on swallowing.

Odynophagia Diagnosis

Specific tests and exams for the diagnosis of the condition are usually not available. Health specialists normally identify the problem on the sole basis of symptoms. Chest X-rays are unable to identify any inflammatory lesions lining the esophagus. If the cause of the swallowing disorder is eosinophilic esophagitis then a blood test may reveal elevated levels of white blood cells. An upper gastrointestinal barium swallow is beneficial to the physicians only in the case of esophageal ulcers and motility disorders. Individuals suffering with the condition usually have a history of alcohol intake and use of non-prescribed inflammatory medications. An upper gastrointestinal endoscopy allows the doctors to inspect the esophageal lining for any inflammatory lesions. In most cases, physicians may suspect a possibility of esophageal cancer for which a biopsy is performed immediately. Further examination of the esophageal tissues or cells by using this technique may reveal the presence of cancerous cells.

Odynophagia Differential Diagnosis

It is difficult for both patients and physicians to differentiate between Dysphagia and Odynophagia due to which the latter condition is often misdiagnosed. The former is a swallowing disorder which normally gives rise to the sensation of food being stuck as it passes through the esophagus. It exhibits difficulty only on swallowing solid foods. In addition to this, there are other ailments that need to be distinguished from this condition. Some of these are:

  • Esophageal burn
  • Lingual tonsillitis
  • Barrett’s esophagus syndrome
  • Pericarditis
  • Crohn’s disease

Odynophagia Treatment

The major goal of the treatment of this disorder is to eliminate the cause of the persistent pain in the chest. Ulcers can be surgically removed. Malignant conditions of the esophagus are treatable with the help of radiation therapy and chemotherapy. Administration of corticosteroids can prove effective in the case of Eosinophilic esophagitis. Elimination of foods that cause this allergic condition can prevent its recurrence.

Prompt administration of antibiotics and oral forms of nasal decongestants can inhibit the upper respiratory infections from spreading to other regions of the body. Antifungal drugs like Flucanazole, Nystatin and Caspofungin can be effectively used in the treatment of esophageal candidiasis. GERD is mainly treatable by the use of antacids to neutralize the stomach acids that has a tendency to regurgitate into the esophagus. A diet consisting of alcohol, caffeinated drinks and peppermint should be strictly avoided as these constituents promote acid reflux.

Post-treatment, patients affected by Odynophagia can show marked improvement – provided the exact cause of the condition is detected properly. Serious health complications may arise if the underlying cause is a malignant condition. If you are experiencing constant pain below the breastbone, immediately report to a healthcare provider for timely treatment and quick recuperation.

References:

http://en.wikipedia.org/wiki/Odynophagia

http://www.wisegeek.com/what-is-odynophagia.htm

http://www.medterms.com/script/main/art.asp?articlekey=25604

http://health.allrefer.com/health/swallowing-pain-or-burning-info.html

 

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