Odynophagia a Warning Sign and Indication for Timely Endoscopy

Should the symptom of odynophagia be considered a warning sign for esophageal cancer or other significant esophageal pathology?

Background: Although the symptom of dysphagia is considered a warning symptom and an indication for endoscopy, the severity of the pathology associated with odynophagia is less established.

Study design: Retrospective cohort.

Setting: NHS Trust in north London.

Synopsis: A retrospective analysis of all patients who underwent esophagoscopy for odynophagia as a primary symptom over an eight-year period (2005-2013) identified 50 patients with a primary complaint of odynophagia. Of patients with odynophagia, 68% had esophageal mucosal lesions: 14 erosive esophagitis, six malignancies, five stricture, four Barrett metaplasia, three ulcers, and two Candida. The prevalence of esophageal mucosal lesions in 68% of patients presenting with the symptom of odynophagia is more than the prevalence of 30% for esophageal lesions typically identified during endoscopy in patients with the chief complaint of dysphagia. The prevalence of esophageal cancer in 12% of patients presenting with odynophagia is high and supports the notion that odynophagia is a warning sign and an indication for timely endoscopy.

Bottom line: Odynophagia is a symptom with a high rate of associated esophageal malignancy. Upper GI endoscopy should be considered in all patients who present with odynophagia.

Citation: Subramaniam S, Goodchild G, Besherdas K. PTU-051 odynophagia – a symptom worth asking about? Gut. 2014;63 Suppl 1:A60-A61.