odynophagia

Odynophagia is the sensation of pain incurred during swallowing. It is distinct from dysphagia, which is the sensation of food sticking or difficulty swallowing. Odynophagia usually indicates injury or inflammation of the esophagus, though oropharyngeal problems can produce similar pain during swallowing.

Common causes include infectious esophagitis (Candida species, herpes simplex virus, cytomegalovirus), pill-induced esophagitis (bisphosphonates, doxycycline, potassium chloride, NSAIDs), reflux esophagitis, eosinophilic esophagitis, and ulcers from chemical or radiation injury. Malignancy and esophageal perforation are important less frequent etiologies, particularly in older patients or after severe vomiting.

Risk factors include immunosuppression (HIV/AIDS, transplant recipients, chemotherapy), older age, diabetes, and taking pills without water or lying down after ingestion. Clinically, odynophagia may occur with fever, weight loss, chest or retrosternal pain, or in association with dysphagia.

Evaluation typically starts with a focused history and examination. Endoscopy with biopsy is the key test when symptoms persist or red flags are present. Ancillary tests may include CBC, HIV testing, and imaging if perforation or mediastinitis is suspected.

Treatment targets the underlying cause. Empirical antifungal therapy may be started for suspected candida esophagitis in immunocompromised patients; discontinue offending medications; treat GERD; dietary modification and topical steroids for eosinophilic esophagitis. Antiviral therapy is used for HSV or CMV when confirmed.

Prognosis is generally favorable with appropriate treatment, but persistent odynophagia warrants further evaluation for structural disease or cancer. Emergent care is required if there is severe pain with inability to swallow, dehydration, chest pain, fever, or suspected perforation.