Pain Originating from the Oesophagus

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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 (See Full Ghana STGs section on ‘Chest Pain’).

Causes

  • 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

Pharmacological  treatment

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, oral,

Adults

200 mg stat.

THEN

100 mg daily for 14 days