Odynophagia is pain during swallowing. Odynophagia may
occur with or without dysphagia and may be caused by mucosal destruction (eg,
GERD-induced esophagitis); bacterial, viral, or mycotic infections; or tumors,
chemicals, or esophageal motor disorders (eg, achalasia, diffuse esophageal
spasm). The patient may describe the pain as a burning sensation or a
substernal tightness typically elicited by very hot or very cold food or
liquid. Pain occurs promptly with swallowing. Severe squeezing chest pain,
induced by swallowing hot or cold beverages in association with dysphagia, is
characteristic of esophageal motor disorders.
http://www.merck.com/mrkshared/mmanual/section3/chapter20/20c.jsp
SYMPTOMATIC DIFFUSE
ESOPHAGEAL SPASM
(Spastic
Pseudodiverticulosis; Rosary Bead or Corkscrew Esophagus)
A generalized neurogenic disorder of esophageal motility in which phasic
nonpropulsive contractions replace normal peristalsis and, in some cases, lower
esophageal sphincter malfunctions occur.
Symptoms
and Signs
Diffuse esophageal spasm typically causes
substernal chest pain with dysphagia for both liquids and solids. The pain may
be severe and may awaken the patient from sleep. Very hot or cold liquids may
aggravate the pain. Over many years, this disorder may evolve into achalasia.
Esophageal spasms may also produce severe pain in
the absence of dysphagia that is indistinguishable from angina pectoris. This
pain is often described as a substernal squeezing pain and may occur in
association with exercise.
Diagnosis
Barium x-rays may show poor progression of a bolus
and disordered, simultaneous contractions or tertiary contractions. Severe
spasms may mimic diverticula but vary in size and position. Esophageal
scintigraphy may be a sensitive method of detecting impaired bolus transport,
but esophageal manometry provides the most sensitive and specific description
of the spasms. Contractions are usually simultaneous, prolonged or multiphasic,
and possibly of very high amplitude. In patients with nondiagnostic baseline
studies, provocative tests with drugs (eg, edrophonium chloride 10 mg IV) or
food may disclose a propensity to symptomatic spasms. Studies show lower
esophageal sphincter pressure or relaxation impairment in 30% of patients.
Treatment
Esophageal spasms are often difficult to treat.
Anticholinergics, nitroglycerin, and long-acting nitrates have had limited
success. Calcium channel blockers given orally (eg, verapamil 80 mg tid,
nifedipine 10 mg qid) may be useful in selected patients. Pneumatic dilation
and bougienage may be helpful. Narcotic analgesics are often needed but may be
habit-forming. Medical management is usually sufficient, but surgical myotomy
along the full length of the esophagus may be needed in intractable cases.
Botulinum toxin injection into the lower esophageal sphincter is a new approach
being used for some patients.
http://www.merck.com/mrkshared/mmanual/section3/chapter20/20f.jsp
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