Introduction Odynophagia can be defined as a painful sensation in the oesophageal region that occurs in relation to swallowing. Unlike dysphagia, which has historically been an alarm symptom or warning sign of oesophageal cancer, odynophagia is not classified as an alarm symptom and does not form part of the suspected upper gastrointestinal (GI) cancer referral form in the UK. Endoscopy is the gold standard imaging modality for the diagnosis of mucosal lesions in the oesophagus. However, there is no clear data regarding the findings at endoscopy in patients scoped for odynophagia. Mucosal abnormalities even in the presence of typical symptoms of gastro-oesophageal reflux disease, namely heartburn and regurgitation are absent in up to 70%. We hypothesise that the presence of odynophagia has a high predictive value of mucosal abnormality at endoscopy and aimed to assess the findings at endoscopy for patients scoped for odynophagia.
Methods A retrospective analysis of all patients who underwent upper GI endoscopy for odynophagia as a primary symptom over an 8-year period (2005–2013) within an NHS Trust in north London was performed. Data was obtained from the Unisoft Endoscopy reporting software. The findings at endoscopy in patients with odynophagia were scrutinised.
Results 50 patients were endoscoped for odynophagia during the study period. 34 of 50 patients (68%) had oesophageal mucosal lesions (4 Barrett’s mucosa, 2 candida oesophagitis, 14 reflux oesophagitis, 6 malignant tumour, 5 oesophageal stricture, 3 oesophageal ulcers). 12% (6 of 50) had oesophageal cancer. A further 10 had hiatus hernia, 1 had a motility disorder and 1 had oesophageal diverticulum.
Conclusion From this study, 68% of patients endoscoped for odynophagia have a positive endoscopic mucosal abnormality. Odynophagia as a symptom has a high sensitivity for abnormal endoscopy. 12% of patients endoscoped for odynophagia had oesophageal cancer. This prevalence is similar to the diagnosis of cancer in patients referred on the ‘two week wait upper GI cancer referral form’. We recommend the symptom of odynophagia be classified as an alarm symptom and those presenting with odynophagia all undergo upper GI endoscopy to define the exact mucosal abnormality and exclude oesophageal cancer.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.