Odynophagia

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Odynophagia is defined as painful swallowing.

• Dysphagia is defined as difficulty in swallowing
• Dysphagia is usually due to muscle or nerve control

Differential Diagnosis

In alphabetical order.

• Abscesses
• Achalasia
• Aerophagia
• Agranulocytosis
• Alcoholism
• Allergic swelling
• Amyloidosis
• Amyotrophic Lateral Sclerosis (ALS)
• Angina tonsillaris
• Anxiety disorders
• Aortic aneurysm
• Aspiration of foreign body
• Barret's Syndrome
• Behcet's Syndrome
• Botulism
• Brainstem stroke
• Bronchial carcinoma
• Bulbar palsy
• Candidiasis
• Cascade stomach
• Central hypoglossal nerve paralysis
• Central vagal nucleus lesion
• Cerebrovascular accident (CVA)
• Chagas Disease
• Chemical burns
• CREST syndrome (calcinosis raynaud's phenomenon esophagus sclerodactyly telangiectasias)
• Cytomegalovirus (CMV)
• Dermatomyositis
• Diabetic neuropathy
• Diphtheria
• Diverticulum
• Enlarged left atrium
• Esophageal cancer
• Esophageal Crohn's disease
• Esophageal diverticulum
• Esophageal moniliasis
• Esophageal sarcoidosis
• Esophageal spasm
• Esophageal trauma
• Esophagotracheal fistula
• Extreme spinal curvature
• Fibrosis
• Food bolus
• Gastric tumors
• Gastritis
• Gastroparesis
• Global hystericus
• Globus syndrome
• Goiter
• Graft versus host reaction
• Guillain-Barre Syndrome
• Herpangina
• Herpes simplex virus (HSV)
• Hiatal hernia
• Huntington's chorea
• Hyperthyroidism
• Hypokalemia
• Hypothyroidism
• Idiopathic human immunodeficiency virusHIV ulcers
• Impaired sensitivity in the larynx
• Intramural pseudodiverticulosis
• Laryngeal cancer
• Lateral funiculus angina
• Leiomyoma
• Ludwig's angina
• Lymph granulomatosis
• Lymphadenopathy
• Medication-induced esophagitis
• Mononucleosis
• Multiple Sclerosis
• Mumps
• Myasthenia Gravis
• Neoplastic (external compression)
• Nutcracker esophagus
• Oral candidiasis
• Osteophytes
• Palatoplegia after damage to the vagal nerve or the accessory nerve
• Paraneoplastic syndrome
• Parkinson's Disease
• Peptic stenosis
• Peripheral neuropathy
• Peripheral tongue paralysis with lesions of the hypoglossal nerve
• Pharyngitis
• Pleural and pericardial causes
• Plummer-Vinson Syndrome
• Poliomyelitis
• Polyradiculitis
• Pseudoachalasia
• Pseudobulbar paralysis
• Pyloric stenosis
• Rabies
• Radiation esophagitis
• Reflux esophagitis
• Rheumatoid Arthritis
• Scarlet Fever
• Schatzki ring
• Scleroderma
• Stevens-Johnson Syndrome
• Stomatitis
• Syringobulbia
• Systemic Lupus Erythematosus
• Tetanus
• Tonsillar abscess
• Typhoid fever angina
• Vascular abnormality
• Vincent's angina
• Zenker's Diverticulum

Diagnosis

History and Symptoms

• Onset
• Severity
• Duration
• Dysphagia with liquids versus solids
• Psychiatric history
• Prior episodes
• Substance exposure
• History of neck and head problems

Laboratory Findings

Electrolyte and Biomarker Studies

• Creatinine phosphokinase (CPK) can be used to rule out cardiac ischemia as a cause.

Electrocardiogram

Can be used to assess for left atrial enlargement.

Chest X Ray

Can used to rule out lung cancer and other mass lesions as well as left atrial enlargement.

MRI and CT

• MRI of brain can be used to exclude CVA and mass lesions of the head and neck.

Echocardiography or Ultrasound

Can be used to rule out an aneurysm or left atrial enlargement as a cause.

Other Diagnostic Studies

• Esophagogastroduodenoscopy (OGD)
• Biopsy
• Barium swallow
• Electromyogram (EMG)
• Nerve conduction tests
• Esophageal manometry

Treatment

• Endoscopy (acute and chronic mechanical obstructions)
• Speech therapy (ALS and stroke patients)

Pharmacotherapy

• Proton pump inhibitors or promotility agents, weight loss, avoidance of offending foods (gastroesophageal reflux disease)
• Anticholinergics (ALS, stroke, lower esophageal spasms)
• Muscarinic agents (myasthenia gravis)
• Glucocorticoids (myasthenia gravis and polymyositis)
• Antispasmodics, botulinum toxin injection (lower esophageal spasm)

Surgery and Device Based Therapy

• Thoracic surgery, possible balloon dilation (chronic mechanical obstruction)

References

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