ODYNOPHAGIA - IS IT A SYMPTOM WORTHY OF 2WW GASTROSCOPY?

Aims Odynophagia is defined as a painful sensation in the oesophageal region that occurs in relation to swallowing. Endoscopy is the gold standard investigation for the diagnosis of mucosal lesions in the oesophagus. Unlike dysphagia, which has historically been an alarm symptom of oesophageal cancer, odynophagia does not form part of the suspected upper gastrointestinal (GI) cancer referral in the UK. We aimed to compare the standard ‘red flag’ indications for gastroscopy to odynophagia in terms of cancer detection.

Methods A retrospective analysis of all patients who underwent upper GI endoscopy for standard upper GI ‘two-week-wait’ (2WW) criteria compared with odynophagia as a primary symptom over a 14-year period (2005-2019) within an NHS Trust in North London. Data was obtained from the Unisoft Endoscopy reporting software. The findings at endoscopy for all indications were scrutinised.

Results Indication (n, malignant oesophageal tumours (%)): Anaemia (17,936, 94 (0.5%)); Dysphagia (10,954, 562 (5%)); Nausea and vomiting (N&V) (6380, 64 (1%)); Weight loss (6157, 119 (2%)); Odynophagia (530, 21 (4%)).

530 patients were endoscoped for odynophagia during the study period. 240 (45%) had oesophageal mucosal lesions: Reflux oesophagitis 193 (36%); Barrett’s oesophagus (26 (5%); Malignant tumour 21 (4%). 32 (6%) had an oesophageal stricture.

Conclusions From this study, almost half of patients endoscoped for odynophagia have a positive endoscopic mucosal abnormality. 4% of patients endoscoped for odynophagia had oesophageal cancer compared with 5% of dysphagia patients. Anaemia (0.5%), weight loss (2%) and N&V (1%) all have inferior cancer pick up rates. We recommend the symptom of odynophagia be classified as an alarm symptom and those presenting with odynophagia all undergo urgent upper GI endoscopy to define the exact mucosal abnormality and exclude oesophageal cancer.