© Springer International Publishing AG 2018Eytan Bardan and Reza Shaker (eds.)Gastrointestinal Motility Disorders doi.org/10.1007/978-3-319-59352-4_20
20. Painful Swallowing
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
KeywordsOdynophagiaPill-induced injuryInfectious esophagitis
It Hurts When I Swallow, Is It My Pill Doing It or an Infection?
Suggested Response to the Patient
There are a number of different reasons for pain with swallowing, and both pill-induced injury and infections are common causes.
There are numerous medications that have been associated with pill-induced injury , including common medications like nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen, etc.) and antibiotics and we will go through your medication list to determine if there is a specific medication that is likely to be contributing and if the way you are taking these medications puts you at increased risk for pill-induced injury. If it is your pill that is suspected to be the cause of the pain with swallowing, oftentimes we will have to stop this medication and see if your pain resolves. If your pain does not improve, we will need to perform further evaluation, possibly endoscopic evaluation, to determine if there is another cause of your pain.
There are various infections including bacteria, fungi, and viruses that can cause pain with swallowing. Patients that are immunosuppressed are often affected by these infections, but they may also occur in those without any immunosuppression. Common causes of infection that cause pain with swallowing include Candida, herpes simplex virus, and cytomegalovirus. There are treatments for these various infections, but it often requires endoscopy with possible biopsy to make the diagnosis.
Once we identify the cause of your pain with swallowing, we will be able to initiate treatment that should improve your pain.
Brief Review of Literature
Odynophagia indicates pain during any component of the swallowing process. This pain occurs with or shortly after the initiation of a swallow. Pain that occurs during the oropharyngeal phase of swallowing has been attributed to various processes including malignancies, foreign body ingestion, and mucosal inflammation and ulceration. Odynophagia occurring later in the swallowing process is commonly caused by caustic injury or infection and suggests the esophageal phase. However, considerations include tumors and other processes associated with deep mural injury including radiation damage and deep peptic ulceration .
In immunocompetent individuals, a common cause of acute esophageal odynophagia is infection with Candida albicans or herpes simplex virus (HSV). Other bacteria, fungi, and viruses such as cytomegalovirus (CMV) and varicella zoster virus are less commonly associated with odynophagia in the immunocompetent. Topical corticosteroids, diabetes mellitus, and malignancy are known to increase the risk for Candida infection of the esophagus. More common offenders for acute esophageal odynophagia in the immunosuppressed are cytomegalovirus and Candida. Immunosuppressed populations that are most affected by infectious esophagitis include HIV/AIDS patients, transplant patients, and those receiving chemotherapy .