Sa1314 ODYNOPHAGIA - IS IT A SYMPTOM WORTHY OF URGENT GASTROSCOPY?

Abstract

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 cancer detection rate of odynophagia to the standard 'red flag' indications for gastroscopy. We performed a retrospective analysis of all patients who underwent upper GI endoscopy for upper GI 'two-week-wait' (2WW) criteria and compared this with odynophagia over a 14-year period (2005-2019) at a tertiary London-based hospital Trust. Data was obtained from the Unisoft Endoscopy reporting software. The findings at endoscopy for all indications were scrutinised. During the study period, a malignant oesophageal tumour was identified in 21 patients (4%) endoscoped for odynophagia (total 530 patients endoscoped for odynophagia). This compared to Anaemia (17936 endoscoped and 94 tumours identified (0.5%)); Dysphagia (10954 endoscoped and 562 tumours identified (5%)); Nausea and vomiting (N&V) (6380 endoscoped and 64 tumour identified (1%)); Weight loss (6157 endoscoped and 119 tumours identified (2%)). Of the 530 patients who 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. 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 that odynophagia be re-classified as an alarm symptom and those presenting with this significant symptom undergo an urgent upper GI endoscopy to define the exact mucosal abnormality and exclude oesophageal cancer.View Large Image Figure ViewerDownload Hi-res image Download (PPT)