Dysphagia- sticking sensation or obstruction on swallowing
Odynophagia- pain on swallowing. It comes form the Greek words odyno– meaning pain and –phagia meaning swallowing.
These are often used incorrectly.
Odynophagia is a condition in which an individual experiences pain each time he or she swallows. Unlike dysphagia, which is a condition where an individual finds it difficult to swallow, odynophagia does not necessarily involve any problems with the process of swallowing itself. For many people, the level of pain is similar when any swallowing activity is attempted, regardless of whether the attempt involves a cold beverage or hot food.
The causes of odynophagia usually have to do with some type of destruction of the mucosa or at least some type of irritation of the mucosa by the habitual consumption of extremely hot or cold food and beverages. Muscular disorders that negatively impact the function of the muscles in the throat can also be a contributing factor to the development of this condition. In some cases, odynophagia causes include the development of cancer in the esophagus, some types of immune disorders, or infections that develop in the upper respiratory tract.
For most people, odynophagia takes the form of an extremely uncomfortable burning sensation each time swallowing is attempted. Along with the burning feeling, many patients also report a sense of squeezing around the throat while attempting to swallow. This discomfort takes place when eating or drinking, but can also occur when simply swallowing as a means of clearing the throat.
Mostly the patients with odynophagia have linear ulcerations on the surface of mucosa on endoscopy.
Most commonly odynophagia is found among immuno suppressive patients.
- The No. 1 cause among them is Candida albicans (Pic 1),
- the No. 2 cause is Cytomegalovirus and
- last but not the least; it is Herpes Simplex Virus (HSV).
If the patient is not immunocompromised and otherwise healthy but still complaints of odynophagia; check out the drugs , if found anyone causing discountinue them.
Odynophagia may be very pronounced in patients with viral (herpetic) esophagitis, monilial esophagitis or Crohn’s disease of the esophagus.
Odynophagia may also occur in patients with an apparently normally looking esophagus as described by Edwards in the tender esophagus syndrome.
In patients with noncardiac chest pain, edrophonium provocation of esophageal motility may induce chest pain in relation to swallowing.
By definition, Odynophagia occurs in a strict temporal relation to swallowing and can therefore readily be ascribed to the esophagus. Odynophagia, therefore, does not pose an important diagnostic problem in patients with noncardiac chest pain.
The most effective means of odynophagia treatment is usually a two-pronged approach, involving treatment of both the underlying cause and the symptoms manifested at the same time. For example, as medication is used to bring the respiratory infection under control, oral medication to help numb the throat and ease the pain during swallowing may be employed. As the infection
weakens, the swallowing pain also begins to lessen.
In situations where acute odynophagia is caused by the presence of cancer, the process of treatment is likely to be extended. Depending on the location and severity of the cancer, radiation and chemotherapy may be used to shrink the tumor and prevent
the spread of the cancer cells. If necessary, surgery may be required to remove the tumor. Once the cancer is brought under control, the patient is likely to find that swallowing becomes less painful over time.
Because there are so many reasons why odynophagia can develop, it is important to see a doctor as soon as the condition begins to take place. Early diagnosis of the underlying cause can expedite recovery, and possibly prevent other health complications if the underlying cause is particularly serious. Since many of the reasons for this condition can be treated with oral prescription
medication, it is possible to get relief from odynophagia within as little as a week.
There are three most common types of dysphagia:
- If it is progressive from solids to liquids most commonly it is due to carcinoma.
- If it is chronic for many months to years; the most common cause is Achalasia.
- and if it is paradoxical (i.e. swallowing of solids is OK but swallowing liquids elicit difficulty than it is also due to Achalasia.
I. Differential for Oropharyngeal Dysphagia:
A. Mechanical= webs, stricture, mass, infection, abscess, congenital defect i.e. cleft palate, extrinsic compression (node, goiter)
B. Motor= neuro and muscular Cerebrovascular Accidents (CVA), Cerebral Palsy, Multiple Sclerosis with bulbar nerve manifestations, Amyotrophic Lateral Sclerosis, MG, Myositis (Diabetes Mellitus, polymyositis)
**Many of these processes can also be seen in the Esophagus
II. Differential for Esophageal Dysphagia:
A. Mechanical= Congenital defects (fistulas), Infection (candidiasis), Webs, Schiatski’s rings, stricture, Tumor, Extrinsic Compression
B. Motor= neuro and muscular neuropathy (DM), Scleroderma, Diffuse Esophageal spasm, Achalasia primary or secondary (ie chagas) Pseudoachalasia due to carcinoma