Odynophagia Treatments Based on Underlying Causes

What Makes Swallowing Feel Less Painful?

Medically reviewed by Isabel Casimiro, MD, PhDMedically reviewed by Isabel Casimiro, MD, PhD

"Odynophagia" is the medical term for pain or discomfort while swallowing. The feeling can be described as burning or squeezing in any section from your neck to your sternum (breastbone). The pain fades when you finish swallowing and the substance leaves your esophagus, which is the tube that connects the back of your pharynx (throat) to your stomach.

Odynophagia can be a serious symptom because it may be a sign of a severe medical problem. It should not be confused with dysphagia, a condition that involves trouble with the act of swallowing. While the two issues can occur at the same time, they are distinct problems.

Painful swallowing can occur for many reasons. Common causes include infection, inflammation, and problems with the structure of the esophagus and/or throat. Treatment varies based on the cause of the problem.

This article describes odynophagia's causes, symptoms, and diagnosis. It also explains treatments and common complications of the problem.

What Leads to Odynophagia?

Odynophagia can occur as the result of several medical conditions, including the following:

Infections involving your tonsils, throat, epiglottis (the tissue at the base of the tongue that covers the windpipe), and esophagus can cause odynophagia. These include:

• Cytomegalovirus (CMV), a chronic viral infection spread through body fluids

• Gingivitis (gum disease)

• Herpes simplex virus (HSV)

• Human immunodeficiency virus (HIV)

• Pharyngitis (sore throat)

• Thrush (yeast infection of the mouth)

• Yeast infection of the esophagus

• Tooth infection or abscess

Structural problems or injuries in your esophagus or the surrounding areas that can cause odynophagia include:

• Achalasia: An inability of the lower esophageal sphincter (a ring of muscle where your esophagus meets your stomach), to relax or allow food to pass through as it should

• Esophageal spasms: Abnormal contractions of the muscles in your esophagus

• Gastroesophageal reflux disease (GERD): A condition in which the muscle at the end of your esophagus does not close properly, allowing acid reflux (the leakage of stomach acid back into your esophagus)

• Inflammation of the esophagus

• Nutcracker esophagus: High pressure and spasms in your esophagus that occur in a coordinated manner

• Eosinophilic esophagitis: A high number of eosinophils (a type of white blood cell) inside the esophagus, causing inflammation and injury

• Ulcers in your esophagus: Especially due to tetracyclines (a type of antibiotic), aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or Advil and Motrin (ibuprofen)

• Throat cancer, esophageal cancer, or other tumors in the surrounding areas

Other sources of damage to your mouth, esophagus, or throat, that can cause odynophagia include:

• Food or foreign objects lodged in your throat, such as fish or chicken bones

• Ingestion of hot, acidic, or spicy substances that cause burns in the mucosal tissue

• Radiation therapy

Odynophagia on One or Both Sides

Painful swallowing can occur on one or both sides of your throat. While painful swallowing typically affects your entire throat, pain on one side may be attributed to problems such as an obstructed foreign body, tumor, ulcer, or abscess on one side of your throat.

Odynophagia Feeling in Throat

The feeling of odynophagia can vary by individual and cause. Generally, the condition causes a feeling in the throat described as pain during swallowing.

Odynophagia can also involve the following symptoms that occur in your throat when swallowing begins or in your chest as food travels toward your stomach:

• Pain when swallowing any substance, including food, liquid, or saliva

• Strong burning or squeezing sensation when swallowing

• Chest pain, typically behind the sternum

• A feeling of food stuck in your throat

• Heaviness or pressure in your neck or upper chest while eating or swallowing

The symptoms and feelings of odynophagia differ from dysphagia, a condition that involves difficulty in the act of passing food or liquid from your mouth to your stomach.

While odynophagia can be linked to a wide range of underlying medical conditions, dysphagia typically involves an issue that weakens or damages the muscles and nerves used for swallowing. These changes interfere with the normal swallowing function.

Dysphagia is most common among older adults and people with conditions that affect the nervous system, such as Parkinson's disease, stroke, dementia, or head injury.

Endoscopy to Diagnose Odynophagia

A sore throat or painful swallowing caused by a virus usually improves within five days. However, a healthcare provider should examine a sore throat with painful swallowing that lasts longer.

Painful swallowing can be a symptom of a serious condition, so it should not be ignored. Getting an accurate diagnosis can help you receive treatment for symptoms and an underlying condition as soon as possible for the best outcomes.

Contact your healthcare provider if you have painful swallowing and any of the following symptoms:

• Abdominal pain

• Bloody stools

• Chills

• Cough

• Fever

• Heartburn
  

• Light-headedness

• Nausea or vomiting

• Shortness of breath

• Sour taste in your mouth

• Stools that appear black or tarry

• Unexplained weight loss
  

• Wheezing

Depending on your symptoms and the findings of a healthcare provider, the following diagnostic tests may be used.

Endoscopy with biopsy: This test uses an endoscope (a flexible tube with a small camera and light at the end) to examine your digestive tract. During the procedure, surgical tools are used to perform a biopsy (extract samples of abnormal tissues) for examination in a laboratory.

Barium swallow and upper GI series: These tests examine your upper gastrointestinal (GI) tract, which includes your mouth, back of your throat, esophagus, stomach, and the first part of your small intestines. It involves swallowing a barium drink to make your upper GI area show up more clearly on X-rays and fluoroscopy (an X-ray that shows organs in motion) while you swallow.

Chest X-ray: This type of X-ray examines the inside of your chest to assess your lungs, heart, and other structures.

Esophageal pH monitoring: This test measures how often stomach acid enters your esophagus and how long it stays there. A small monitor is attached to the upper lining of your esophagus, where it measures acidity and transmits pH levels (a measure of acidity and alkalinity) to a recording device, usually for 24 hours.

Esophageal manometry: This test uses a small, flexible catheter to measure the function of your esophagus. The catheter is inserted through your nasal passage into your esophagus and passed into your stomach. Pressure sensors measure the pressure of the upper and lower esophageal valves and contractions as you swallow.

Esophagogastroduodenoscopy (EGD or upper endoscopy): This type of endoscopy examines your upper GI tract, which includes the lining of the esophagus, stomach, and upper part of the duodenum (the first section of the small intestine).

HIV test: This test is used to determine whether you have acquired HIV. It can be performed using a sample of blood, saliva, or urine. Your healthcare provider will advise the best testing option based on your symptoms and other factors regarding the likely time of infection.

Throat culture or rapid tests for causes of infection: These tests often involve swabbing the back of your throat with a long cotton swab to obtain a sample. Rapid tests, such as for strep, can provide quick results. If a culture is needed, the swab is sent to a laboratory for further analysis to identify organisms causing an infection.

Odynophagia Treatment

Odynophagia treatment varies based on the underlying cause. Treatments for common problems include:

• Administration of Zirgan (ganciclovir), an antiviral used to treat cytomegalovirus

• Administration of antibiotics for bacterial infections

• Administration of antifungals for the treatment of yeast infections

• Steroids for HIV

• Endoscopic extraction of ingested foreign bodies, followed by repair of perforations or tears in the esophagus or other affected areas

• Antacids, Carafate (sucralfate), or proton pump inhibitors (PPIs) for GERD

• Surgical repair of esophageal tears

Treatment of an underlying condition or an esophageal injury can take time to promote a return to pain-free swallowing. You may be able to ease swallowing pain with the following strategies:

• Stop smoking since it can irritate your throat.

• Use over-the-counter lozenges or throat sprays.

• Try a local anesthetic containing lidocaine (spray or oral solution) to numb your throat.

• Manage pain with NSAIDs or Tylenol (acetaminophen).

Making the following changes to your diet and eating habits can help you get the nutrition you need with painful swallowing:

• Choose soft or moist foods and foods that are easier to chew and swallow.

• Try pureed foods or liquids if solid foods are hard to swallow.

• Finely chop, mince, blend, or puree foods to soften them.

• Consume beverages with your meal and sip as you eat to moisten your mouth and help the food go down.

• Use a straw if your mouth is irritated.

• Add sauces or gravies to goods to increase moisture and enable easier swallowing.

• Avoid very cold or very hot foods if they make your symptoms worse.

• Avoid or soften dry, crunchy, or abrasive foods such as cookies, nuts, and chips.

• Avoid foods that sting or irritate your mouth or throat, such as salty or spicy foods, acidic foods like fruit/vegetable juice or vinegar, extremely hot or cold food and drinks, and alcohol.

• Eat slowly and chew your food well.
  

Secondary Complications of Odynophagia

When odynophagia is a sign of an underlying medical condition, delaying diagnosis and treatment can lead to complications related to the untreated problem. In cases of chronic diseases like GERD or cancer, the disease may worsen when treatment is delayed.

Living with odynophagia for any reason can lead to the following secondary complications:

• Inability to consume adequate food, nutrition, and hydration to meet your needs and maintain your weight

• Reduction in quality of life as a result of poor nutrition

• Unintended weight loss due to an inability to consume food without pain
  

Summary

Odynophagia, or painful swallowing, can feel like an intense burning or squeezing when you swallow. It can occur in any area from your neck to your breastbone.

Painful swallowing can result from many health problems, such as infections, GERD, and damage from objects stuck in your throat. The pain can prevent you from getting the food and liquids you need for proper nutrition, affecting your quality of life by causing fatigue and stopping you from living fully.

Lozenges, numbing sprays, NSAIDs, and other over-the-counter pain medication can relieve symptoms of painful swallowing. However, treating the underlying cause of painful swallowing is the only way to achieve long-term relief.

Contact a healthcare provider if you have painful swallowing that lasts more than a few days or involves other symptoms like weight loss. Finding the cause of odynophagia can help you get the treatment you need.

Read the original article on Verywell Health.