From the Guidelines
Odynophagia, or painful swallowing, requires immediate medical attention to rule out serious underlying conditions, and patients should undergo an oesophago-gastro-duodenoscopy (OGD) with biopsy to exclude eosinophilic oesophagitis and other mucosal or structural causes, as recommended by the British Society of Gastroenterology guidelines 1. The diagnosis of odynophagia involves a thorough evaluation of the patient's symptoms, medical history, and physical examination. Common causes of odynophagia include esophagitis, pharyngitis, tonsillitis, oral thrush, gastroesophageal reflux disease (GERD), or esophageal ulcers. Treatment depends on the underlying cause but may include:
- Antacids or proton pump inhibitors like omeprazole 20mg daily for GERD-related pain
- Antifungal medications like fluconazole for thrush
- Antibiotics for bacterial infections While waiting for medical evaluation, patients can find temporary relief by:
- Consuming soft, cool foods
- Avoiding spicy or acidic items
- Staying well-hydrated Recent data has focused specifically on the potential for inflammatory and infectious etiologies to lead to dysmotility, and a high index of suspicion is necessary to diagnose immune-mediated disorders that may cause esophageal dysfunction, including odynophagia 1. In addition to the underlying cause, the patient's nutritional status and swallowing function should be evaluated, especially in patients with neurological disorders, as dysphagia and odynophagia can lead to malnutrition, dehydration, and aspiration pneumonia 1. Therefore, a comprehensive diagnostic approach, including OGD and biopsy, is essential to determine the underlying cause of odynophagia and guide appropriate treatment, as recommended by the British Society of Gastroenterology guidelines 1.
From the Research
Definition and Causes of Odynophagia
- Odynophagia refers to painful swallowing caused by various underlying factors that must be excluded to determine the best treatment approach 2.
- It can be caused by several factors, including tendinitis of the longus colli muscle and paravertebral calcification, prevertebral and retropharyngeal abscess, esophageal perforation, aortic dissection, thyroid cartilage fracture, thyrohyoid ligament syndrome, pneumomediastinum and subcutaneous emphysema, and after physical exercise 2.
Diagnosis and Assessment of Odynophagia
- A differential diagnosis is crucial to ensure appropriate referrals for therapeutic interventions 2.
- The barium swallow is a commonly performed investigation that can help diagnose esophageal dysphagia, including odynophagia 3, 4.
- Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia, which can include odynophagia 5.
Treatment and Management of Odynophagia
- Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia, including odynophagia 5.
- Nutritional intervention and an oral care program were also recommended for patients with dysphagia, including odynophagia 5.
- The treatment of esophageal dysphagia, which can include odynophagia, is a challenging role for gastroenterologists, and may require interdisciplinary supervision 6.