Odynophagia is the medical term for pain or discomfort when swallowing. When you swallow, you may feel a burning or squeezing sensation anywhere from high in your throat or neck down to your sternum (breastbone).
Conditions that cause inflammation, irritation, or damage to the tissues of the throat, mouth, or esophagus (food pipe) can cause odynophagia. Sometimes, odynophagia is a short-term issue that develops in response to infections. In other cases, persistent (chronic) odynophagia can be a sign of an underlying condition affecting the esophagus, such as gastroesophageal reflux disease (GERD) or eosinophilic esophagitis (EoE).
Treatment for odynophagia depends on the cause and may include lifestyle modifications, medications, or surgery.
How odynophagia feels varies from person to person. It generally begins when you start swallowing food or liquid and ends when swallowing is complete. You may feel it in the back of your mouth or throat as you begin swallowing, in your chest behind your breastbone as food or liquid travels down your esophagus, or throughout the entire swallowing process.
The sensation of odynophagia can range from mild discomfort to severe pain and can affect one or both sides of the throat. You may be only vaguely aware of the pain as food or liquid moves down your throat, or it may be so severe that swallowing is unbearably painful and prevents you from eating or drinking.
Depending on the cause, odynophagia may feel like:
- Burning sensations in your throat or chest
- Throat tightness
- Squeezing in your chest or throat
- Pressure or heaviness in your neck or chest
Odynophagia often occurs with other symptoms, which can help healthcare providers determine the cause. Common symptoms that occur with painful swallowing include:
- Dysphagia (difficulty swallowing)
- Chest pain (unrelated to swallowing)
- Regurgitation
- Feeling a lump in your throat or as if something is stuck in your throat
- Weight loss
- Heartburn
- Nausea or vomiting
- Hoarseness
- Persistent cough
- Fever
Odynophagia Causes
Odynophagia can develop from acute (short-term) and chronic (long-term) conditions that irritate, inflame, or damage the mouth, throat, esophagus, or neck tissues.
Infections
Infections are a leading cause of odynophagia. Viral, bacterial, and fungal infections can cause inflammation and irritation in the structures of the throat, including the esophagus (food pipe), trachea (windpipe), and tonsils.
- Viral infections: Viral infections like the common cold, influenza (flu), COVID-19, or cytomegalovirus (CMV) can lead to odynophagia. These viruses can inflame the structures and tissues in the throat, causing painful swallowing and other symptoms like runny nose, fatigue, cough, and body aches.
- Bacterial infections: Bacterial infections such as streptococcal pharyngitis (strep throat) can cause intense pain when swallowing. These infections often result in red, swollen tonsils and throat, sometimes accompanied by white patches, fever, chills, and swollen lymph nodes in the neck.
- Fungal infections: Fungal infections like oral thrush, a fungal infection caused by the yeast Candida albicans, can cause odynophagia. Symptoms include painful swallowing, white, velvety patches on the tongue and mouth, and bleeding when you brush your teeth or scrape the sores.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, or GERD, is when stomach acid flows back into the esophagus (acid reflux), irritating its lining. Recurrent (repeated) acid reflux causes inflammation in the esophagus and can lead to symptoms like painful swallowing, heartburn, a sour or bitter taste in the mouth, and nausea. Hoarseness, chronic cough, and regurgitation (bringing food back up) can also occur.
Left untreated, GERD can cause ulcers on the lining of the esophagus, making swallowing more painful.
Your risk of developing GERD is higher if you smoke, drink alcohol, or lie down within three hours after eating. People with obesity, scleroderma, and hiatal hernia (when part of the stomach protrudes through a diaphragm opening) also have an increased risk.Scleroderma is an autoimmune condition that causes thickening of skin and other body tissue.
Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory condition that develops when eosinophils—specialized white blood cells that play a role in the body's immune response—build up in the esophagus. Typically, there are no white blood cells in the esophagus.
In people with EoE, exposure to allergens, such as food or environmental allergens, causes eosinophils to collect in the esophagus, leading to inflammation. EoE can cause painful swallowing, difficulty swallowing, heartburn, and chest pain.
People with other allergic diseases, such as asthma, eczema, seasonal allergies (hay fever), and food allergies, are more likely to develop EoE.
Medication-Induced Esophagitis
Medication-induced esophagitis, or pill esophagitis, occurs when certain medications irritate and inflame the esophagus. Taking oral medicines without drinking adequate amounts of water or right before lying down can lead to the pill getting stuck in the esophagus. When the pill partially or wholly dissolves in your esophagus, it can injure the esophageal tissues and lead to odynophagia. You may also experience chest pain or back pain.
Medications associated with an increased risk of pill esophagitis include antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates (osteoporosis medications).
Esophageal Cancer
Esophageal cancer develops when abnormal cells multiply and grow out of control, forming a tumor in the esophagus. Odynophagia occurs with esophageal cancer when the tumor is large enough to interfere with normal swallowing. This causes pain when food or liquid reaches the tumor's location or within a few seconds after swallowing.
Other symptoms include pain behind the breastbone, difficulty swallowing, hoarseness, chronic cough, and unintended weight loss. Heavy alcohol use, smoking, and Barrett's esophagus can increase the risk of esophageal cancer, and the risk increases with age.
Nutcracker Esophagus (Hypercontractile Esophagus)
Nutcracker esophagus, or hypercontractile esophagus, is a motility (movement) disorder that causes excessively forceful esophageal contractions during swallowing. These intense contractions can cause severe odynophagia, chest pain, and difficulty swallowing.
The causes of nutcracker esophagus are not fully understood, but research suggests abnormal nerve signaling between the brain and nerves controlling the esophageal muscles may play a role.
Less Common Causes
Other possible causes of odynophagia include:
- Achalasia: A rare esophageal motility disorder in which nerve damage in the esophagus makes it difficult for the esophageal muscles to move food down toward the stomach.
- Injury: Swallowing substances that harm the lining of the esophagus, such as chicken or fish bones or caustic (acidic) substances, can lead to odynophagia. Radiation therapy (cancer treatment) to the head or neck can also damage esophageal tissues and cause painful swallowing.
- Esophageal stricture: Narrowing of the esophagus can make it more difficult for food and liquid to move from the throat to the stomach, causing painful swallowing. GERD, eosinophilic esophagitis, injury to the esophageal tissues, and long-term use of a nasogastric (NG) tube are common causes of esophageal strictures.
- Autoimmune conditions: Certain autoimmune disorders—such as rheumatoid arthritis (RA), Crohn's disease, connective tissue disorders, systemic sclerosis, and scleroderma—can affect the structure and function of the esophagus and cause odynophagia. Autoimmune conditions occur when the immune system mistakenly attacks healthy cells, tissues, or organs.
Odynophagia from viral infections, such as the common cold, typically resolves within a few days. However, it's important to see a healthcare provider for persistent or severe painful swallowing or if you experience odynophagia with any of the following symptoms:
- Abdominal pain
- Cough
- Fever
- Chills
- Nausea or vomiting
- Wheezing (whistling sounds during breathing)
- Sour or bitter taste in the mouth
Seek prompt medical attention for odynophagia that occurs with:
- Bloody stools or stools that appear black or tarry
- Dyspnea (shortness of breath)
- Lightheadedness
- Weight loss
Your healthcare provider will perform a physical examination, ask about your symptoms, and may order diagnostic tests like an endoscopy or esophagram (barium swallow test) to view the esophagus and determine the underlying cause of odynophagia.
- An endoscopy is a procedure that involves inserting a thin, flexible, lighted tube with a camera, or endoscope, to examine the inside of the body.
- For an esophagram, you will swallow a liquid containing barium (a soft metal visible on X-rays) that coats the esophagus and upper gastrointestinal tract. X-ray pictures are taken as you swallow to help visualize the movement of the liquid down your throat.
Treatments for Odynophagia
The goal of odynophagia treatment is to manage and reduce pain when swallowing and address the underlying cause. Treatment approaches vary, depending on the underlying cause.
Home Remedies
Home remedies and adjustments to your eating habits may help ease painful swallowing:
- Hydrate: Drinking plenty of fluids can help soothe an irritated throat and prevent dehydration.
- Gargle with warm salt water: Gargling with warm salt water can reduce throat inflammation and relieve pain.
- Eat slowly: Take your time eating, eat smaller bites of food, and chew thoroughly before swallowing.
- Consume soft foods: If solid foods are too painful to swallow, consume soft or liquid foods, such as pudding, soups, and smoothies.
Medications
Your healthcare provider may prescribe medications to manage odynophagia and treat the underlying cause. When home remedies are insufficient, medications may be necessary to manage symptoms:
- Analgesics: Over-the-counter (OTC) pain relievers like Tylenol (acetaminophen) and Advil (ibuprofen) can temporarily relieve pain.
- Antacids and acid suppressants: Antacids and proton pump inhibitors (PPIs) can reduce acid reflux and associated pain for GERD-related odynophagia.
- Antibiotics, antivirals, or antifungals: If the cause is a bacterial, viral, or fungal infection, your healthcare provider will prescribe medications to clear the infection.
Surgery
In severe or persistent cases, surgery may be necessary to address the underlying cause and relieve odynophagia.
- Fundoplication: GERD-related odynophagia may require fundoplication. This procedure involves wrapping the stomach's upper portion to the esophagus's lower end, helping strengthen the lower esophageal sphincter (LES) to reduce acid reflux.
- Esophageal dilation: This procedure stretches or dilates narrowed esophagus areas, relieving pain and difficulty swallowing.
It is not always possible to prevent odynophagia. However, certain lifestyle habits may help lower your risk, including the following:
- Avoid smoking: Smoking can irritate the esophagus and increase the risk of GERD and esophageal cancer.
- Manage acid reflux: If you have GERD or frequently experience heartburn after eating, follow your treatment plan, avoid eating late at night, and eat smaller, more frequent meals to reduce symptoms.
- Safe medication use: Swallow prescription medications and supplements with plenty of water and avoid lying down immediately to prevent esophagus irritation.
- Avoid allergens: If you have food or environmental allergies, avoid known allergens that trigger symptoms to prevent eosinophilic esophagitis.
- Dietary habits: Avoid spicy, acidic, or scorching hot foods that can irritate the esophagus. Eat slowly and chew thoroughly to reduce the risk of swallowing large chunks that could irritate or injure the esophagus.
Complications
It's important to see a healthcare provider for persistent or severe odynophagia. Left untreated, odynophagia and its underlying cause can worsen and lead to complications.
For example, avoiding eating and drinking to prevent discomfort can lead to unintended weight loss, nutritional deficiencies, malnutrition, and dehydration.
Odynophagia, or painful swallowing, has several possible causes, including infections, gastroesophageal reflux disease (GERD), esophageal disorders, and esophageal injury. While some cases of mild odynophagia may resolve without treatment, most causes require medical attention to diagnose and treat the underlying cause.
Treatment approaches, including home remedies, medication, and surgeries, focus on managing pain and addressing the underlying cause.
See a healthcare provider if you experience odynophagia for more than a few days. Untreated odynophagia can lead to complications like dehydration, nutritional deficiencies, or malnutrition.
