Pain in the esophagus is often difficult to identify unless it occurs during swallowing (odynophagia). Since most of the esophagus runs through the chest cavity, esophageal pain is often described as chest pain and more serious causes like disorders of the heart, great vessels and airways need to first be excluded if pain is the only presenting symptom. Differentiating between cardiac and non-cardiac chest pain is therefore important as the former is often a medical emergency.
Esophageal pain presents as pain in the center of the chest, sometimes also described as breastbone pain. It may accompany swallowing, aggravate in certain positions or occur spontaneously and persist for long periods of time. Pain in the esophagus is often related to inflammation (esophagitis) although there are some non-inflammatory causes of esophageal pain. The character of the pain may vary – a burning chest pain is often associated with gastric acid (heartburn) while a sharp pain may be related to a foreign body lodged in the esophagus or esophageal tears. Dysphagia (difficulty swallowing) may also be seen in esophageal pain, either due to impaired esophageal motility, mechanical obstruction or apprehension over swallowing due to the pain.
Causes of Esophageal Pain
The causes of pain in the esophagus may be related to pathology within the esophagus or referred to the esophagus usually from neighboring structures like the stomach.
Esophagitis is frequently seen in gastroesophageal reflux disease (GERD) as the rising acid irritates the esophageal lining. It typically presents as burning pain although it may be sharp and severe in nature and is often mistaken for cardiac pain. There are other causes of esophagitis related to autoimmune causes (eosinophilic esophagitis), ingestion of caustic substances (corrosive esophagitis) and infections (infectious esophagitis). These causes are discussed further under Types of Esophagitis.
Injury to the esophagus may be due to a number of causes. A foreign body that enters the esophagus (like a fish bone or small sharp toys ingested by infants) can lodge in the esophageal lining or cause tears. Very hot foods or drink may also cause trauma to the esophageal lining.
Nerve and Muscle Disorders
Achalasia arise as a result of a disorder of the nerves suppling the muscles that make up the lower esophageal sphincter (LES). Failure of the LES to relax and allow food to empty into the stomach may result in a back flow of food which can cause dilatation of the gullet. This stretching is often painful.
Esophageal spasms – diffuse esophageal spasm and nutcracker syndrome – often results in chest pain. This occurs as a result of the esophageal muscles constricting abnormally or excessively. The spasm may result in pain.
Dysphagia and regurgitation is often seen in neurological and muscular causes of esophageal pain.
An esophageal ulcer often occurs as a result of GERD. It is usually preceded by esophagitis and is often associated with a gastric ulcer, which may cause referred pain to the esophagus.
Esophageal carcinoma may result in pain as the condition progresses. Depending on the site and size, other symptoms like dysphagia and regurgitation may be noticed. Gastric carcinoma may also cause referred pain to the esophagus.
- Esophageal varices
- Esophageal strictures
- Mallory-Weiss tear
- Zenker’s diverticulum
- Hiatal hernia