Oscar M. Laudanno and Daniel Finkelstein

Odynophagia is called the existence of dysphagia plus pain, that is, a painful dysphagia.

Causes of odynophagia

A very frequent one is the impaction of foreign bodies in the pharyngeal or esophageal region, commonly observed in children after ingesting coins or toys, and in adults fish bones, chicken bones, prostheses, etc. The most common site of impaction is in the middle esophagus, and can also occur in the cervical and pharyngo-laryngeal region.

It is a symptom of sudden onset (esophageal colic) and is due to the development of powerful secondary contractions designed to advance the obstacle. The adult patient can topographically point to the site of pain, which often coincides with the site of impaction of the foreign body.

For diagnosis, the barium-soaked cotton test can be used; For this purpose, a cotton tassel is prepared that is about 2 cm in diameter, dipped in barium and given to ingest. Two alternatives can occur; that the tassel continues long or that it is stopped in some sector of the esophageal path. In this last instance, the spine is impacted and it is necessary to remove it by fibroscopy or by rigid esophagoscopy. In other cases of foreign body impaction, a tongue depressor is used, followed by indirect laryngoscopy if the site of impaction is high. A radioscopic study of the chest may be made in the forehead and profile position, which may reveal a metallic foreign element. Once the foreign body has been removed, a radiological study of the esophagus will be performed to observe the rest of the organ.

Another important cause of odynophagia is reflux esophagitis, which is due to hypotonia of the lower esophageal sphincter, which conditions gastroesophageal reflux. The pain appears in the lower retrosternal area, and may be accompanied by heartburn and / or regurgitation. The diagnosis is based on objective documentation of gastroesophageal reflux (attached table).

Diffuse esophageal spasm is a more frequent pathology in the elderly, predominantly female, associated with an important nervous component. Abnormal contractions in intensity and duration appear in the esophageal body, mainly in its lower third. It produces precordialgia; therefore, it is vitally important to make the differential diagnosis with anginal pain (angina pectoris); unlike it, it is not triggered by effort and its duration is variable, although it can also calm with trinitrine. The diagnosis can be suspected by radiology, which must be carried out, preferably, at times of retrosternal pain. It is possible to observe a series of tertiary, non-propulsive tertiary waves, configuring a picture called a curly corkscrew esophagus or "curling"

Esophageal cancer is also a cause of odynophagia. Pain can occur with swallowing or be permanent. It can simulate coronary pain, with different locations at the level of the sternum, marking with some approximation the obstructed site; generally appears with solid foods; and when the patient stops eating these foods, the pain disappears. The cancerous is a patient who deteriorates, loses weight, and is anorexic, asthenic, and in poor general condition. Radiologically, obstruction can be observed at different levels of the esophagus.

Other causes of odynophagia are ulcerative pharyngitis, Vincent's angina, Piummer-Vinson syndrome, descending, bacterial or fungal (Candida), viral (herpetic), drug (tetracycline and aspirin) esophagitis, and originated by substances that produce chemical esophagitis, accidentally ingested by children and / or in a suicide attempt in the case of adults (caustic soda).