Odynophagia Treatment in Delhi, India

Odynophagia can be classified into three main types based on current surveys and studies conducted by medical professionals:

1. Ulcerative Odynophagia: This type is characterised by the presence of ulcers with broad or flat margins in the oesophagus. Ulcerative odynophagia is the most common type observed among patients.
2. Hyperplastic Odynophagia: In hyperplastic odynophagia, there is constriction and stricture development in the oesophagal lumen due to an exaggerated reaction.
3. Granular Odynophagia: Granular odynophagia is associated with the presence of small, multiple military mucosal granulomas. Granulomas are tiny aggregates of immune cells that develop in infected or inflamed areas of the body. While granulomas are most commonly found in the lungs, they can also occur in other body parts, including the mouth, throat, and oesophagus.

The symptoms of odynophagia can vary depending on the source of the pain.

Common symptoms of odynophagia include:

• Gradual burning discomfort or severe, piercing pain in the mouth, throat, or oesophagus during swallowing.
• Increased pain while swallowing dry food, although liquids and solids may cause similar levels of discomfort.
• Reduced food consumption leads to weight loss.
• Dehydration due to a decrease in fluid intake.

In cases where an infection is the cause of odynophagia, additional symptoms such as fever, fatigue, pain, and a general sense of illness may be present.

There are various factors that can contribute to swallowing discomfort or odynophagia, including:

• Infections: Common infections like colds, flu, and throat disorders can lead to odynophagia.
• Inflammation: Inflammation in the mouth, throat, and oesophagus, such as that caused by Candida, can result in odynophagia.
• Gastroesophageal Reflux Disease (GERD): When stomach acid flows back into the oesophagus and occasionally reaches the throat, it can cause discomfort and irritation. Persistent heartburn can lead to ulceration and dysphagia, which can contribute to odynophagia.
• Weak Immune System: Individuals with weakened immune systems, such as those with AIDS or HIV or those undergoing cancer treatments like radiotherapy, are more prone to developing odynophagia.
• Lesions or Ulceration: Physical injury, surgical procedures, or consuming food with sharp corners can lead to the development of mouth, throat, or oesophagal lesions or ulcers.
• Irritants: Tobacco, alcohol, and illicit drugs can irritate the throat, mouth, and oesophagus, causing discomfort during swallowing.
• Temperature Extremes: Consuming very hot or cold beverages over an extended period can damage the mucous lining of the oesophagus, resulting in odynophagia.

Other infections, such as pharyngitis, tonsillitis, esophagitis, and laryngitis, can also contribute to odynophagia.

To determine the cause of swallowing difficulty or odynophagia, healthcare practitioners typically perform several diagnostic tests, including:

1. X-ray with Contrast Material (Barium X-ray): This test involves giving the patient a barium solution to drink, which marks the oesophagus and allows for better visualisation of X-rays. Muscle activity can be analysed, and the presence of any abnormalities can be observed.
2. Dynamic Swallowing Study: Barium-coated meals of varying consistencies are swallowed, and X-rays are taken to observe the movement of the food through the throat. This test helps identify any issues with tongue and throat muscle coordination.
3. Endoscopy: An endoscope, a small, flexible illuminated tool, is inserted through the throat to visually examine the oesophagus. Biopsies may be taken during this procedure to check for irritation, constriction, eosinophilic esophagitis, or tumours.
4. Fiber-optic Endoscopic Evaluation of Swallowing: A camera and a lighted tube are used to observe the throat while the patient swallows, providing real-time visual information on swallowing function.
5. Esophageal Muscle Test (Esophageal Manometry): This test measures the function of the lower oesophagal sphincter and oesophagal muscles to determine if food can be moved properly from the mouth to the stomach.
6. Imaging Scans: Computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may be conducted to generate detailed images, helping identify any abnormalities.

The treatment of odynophagia depends on the underlying cause. Here are some common treatment approaches:

1. Medications: Specific medications can be prescribed based on the underlying health condition causing the uncomfortable swallowing. For example, medications for GERD can help reduce acid reflux and alleviate pain during swallowing. Antifungal medications may be used to treat Candida infections.
2. Surgery: In cases where there is an oesophagal tumour or carcinoma, surgical excision of the cancer cells may be recommended. If medication fails to effectively manage GERD, surgical intervention may be considered.
3. Time: In cases where no underlying medical condition is detected, odynophagia may subside over time. This is often the case with odynophagia resulting from a common cold or a strong allergic reaction.

The complications associated with odynophagia depend on the underlying condition and the effectiveness of treatment. Some potential complications include:

• Upper Respiratory Tract Infections: Severe odynophagia can increase the risk of pneumonia, otitis, meningitis, orbital infections, encephalitis, and systemic infections.
• Gastroesophageal Reflux Disease (GERD): Untreated or poorly managed GERD can lead to complications such as abnormal narrowing of the oesophagus, weight loss, Barrett's oesophagus, erosive esophagitis, oesophagal ulceration, and oesophagal adenocarcinoma.
• Tumour Growth: In some cases, odynophagia may be associated with the presence of tumours. The complications can include metastasis, constriction of the food tube, weight loss, and deep vein thrombosis.
• Foreign Body Complications: If a foreign body is the cause of odynophagia, complications may include non-invasive or invasive infections, local inflammation, and other related issues.
• Esophagitis: Chronic inflammation of the oesophagus can lead to complications such as stricture formation, weight loss, and bacterial infections.

The risk factors for odynophagia vary depending on the underlying cause. Some common risk factors include:

• Weakened immune system (e.g., HIV/AIDS, cancer treatments)
• Chronic gastroesophageal reflux disease (GERD)
• History of mouth, throat, or oesophagal lesions or ulcers
• Tobacco and alcohol use
• Exposure to irritants
• Previous surgeries or injuries in the mouth, throat, or oesophagus

In many cases, odynophagia resolves on its own, particularly if it is caused by a common cold or flu. The prognosis depends on the underlying condition causing the swallowing pain.

Reviewed by Dr. Vibhor Pareek, Consultant, Gastroenterology, Hepatology & Endoscopy on 29-May-2023.