Introduction
Oesophageal pain is usually burning in quality and tends to be localised behind the sternum.
Oesophageal pain may be associated with difficulty in swallowing (dysphagia).
Dysphagia to water suggests achalasia, while that to solids and not water suggests mechanical obstruction by tumour or stricture.
It may sometimes be confused with other causes of chest pain.
Causes of Oesophageal pain
- Irritation of the oesophageal mucosa by reflux of the acidic contents of the stomach (Gastro-oesophageal Reflux Disease (GORD)
- Oesophageal candidiasis
- Hiatus hernia
- Achalasia
- Spasm of the oesophageal muscle in response to obstruction.
- Oesophageal tumours
Symptoms of Oesophageal pain
- Retrosternal chest pain worsened by swallowing (pain worse on lying flat may suggest GORD)
- Regurgitation of ingested material
- Difficulty in swallowing
Signs of Oesophageal pain
Usually none
- Patient may be obese or severely underweight in the case of GERD
- Severe weight loss may suggest tumour or candidiasis from immune suppression
- There may be oral candidiasis in the case of oesophageal candidiasis
Investigations
- Barium swallow
- Oesophago-gastroduodenoscopy (upper Gl endoscopy)
- Oesophageal manometry when achalasia is suspected
Treatment for Oesophageal pain
Objectives
- To relieve pain
- To treat identified cause
Pharmacological treatment
A. For GERD
1st Line Treatment
Evidence Rating: [B]
Omeprazole, oral,
Adults: 20 mg 12 hourly for 14 days
Or
Esomeprazole
Adults: 20-40 mg daily for 14 days
B. For patients not responding to monotherapy with PPI
Evidence Rating: [B]
Omeprazole, oral, 20 mg 12 hourly for 14 days
Or
Esomeprazole, oral, 20-40 mg daily for 14 days
And
Magnesium trisilicate, oral, 10 ml 8 hourly for 10 days
C. For oesophageal candidiasis
Evidence Rating: [A]
Nystatin, oral,
- (Swish in mouth for several minutes and then swallow)
Adults 400,000-600,000 units 6 hourly for 7 days
Or
Fluconazole,
Adults: 200 mg stat.
Then
100 mg daily for 14 days
Referral Criteria
Refer to a specialist for confirmation of diagnosis and management.