chest pain when swallowing on the right

Chest pain when swallowing is a typical gastroenterological sign, since in all cases it indicates the development of one or another pathological process affecting a gastrointestinal organ such as the esophagus. The most common source of this symptom is considered to be spasm of the esophagus, but experts in the field of gastroenterology identify many more predisposing factors that have a pathological basis.

In addition to disruption of the movement of the food bolus through this organ, the clinical picture will be based on symptoms characteristic of diseases of the digestive tract. The most common of them are the inability to swallow not only solid but also liquid food, belching and heartburn, as well as a burning sensation in the chest area.

To find out the cause of pain in the sternum during food consumption, patients are prescribed a wide range of laboratory and instrumental examinations. The tactics of therapy are completely dictated by the provoking factor, but in the vast majority of cases, conservative treatment methods are sufficient.

Etiology

As mentioned above, pain in the chest during swallowing is caused by disorders associated with the esophagus. It follows from this that the following pathologies of this organ will be provoking factors:

• spasm of the esophagus, which can be diffuse and segmental. In the first case, dysfunction of smooth muscles is observed throughout its entire length. The second situation is characterized by excessive contraction of the muscles of the esophagus in a certain area. This means that at some point the food will not be able to pass any further;
• hiatal hernia;
• achalasia cardia;
• GERD;
• perforation of the wall of this organ;
• injury to the esophagus by a foreign object entering it;
• spontaneous rupture of the esophagus - this can occur against the background of suppression of vomiting or sphincter dysfunction caused by severe alcohol intoxication or pathologies of the central nervous system;
• chemical or thermal burns of the mucous layer of the esophagus;
• the occurrence of peptic esophagitis;
• the formation of oncological, less often benign, neoplasms;
• ulcerative lesions of the esophagus;
• scar formation on the sphincter;
• esophageal dyskinesia;
• damage to the mucous layer of this organ by an erosive or inflammatory process

The pathogenesis of pain in the chest area is that the food bolus moves through the esophagus due to a certain coordination of the movements of the esophageal tube. If such an automatic process for the human body is disrupted for one of the above reasons, then food will pass through with some difficulty or accumulate in one of the departments of this organ. This, in turn, will lead to its stretching and, as a result, the occurrence of pain. In situations where such a disorder is a consequence of one or another illness, drinking a little water will not be enough to relieve the discomfort. Moreover, in some situations this can further increase pain.

Esophagus hurts: causes (additional)

1. A hiatal hernia is a chronic pathological condition in which the esophagus is displaced through a hole in the diaphragm.

2. This condition provokes inflammation of the esophagus (esophagitis). A symptom of a hernia is pain in the left side of the chest, which intensifies after exercise, coughing, burping or eating.

3. Esophageal diverticula are a process of protrusion of the walls of this organ. There may be one or more diverticula in one esophagus. They appear in those people who have greater flexibility of the walls of the esophagus to pressure.

Symptoms of diverticula include nighttime cough, foreign body sensation in the throat, and regurgitation.

4. Esophageal achalasia is a disease in which the esophagus becomes dilated. The reasons for its appearance are considered:

• eating cold food;

• acute deficiency of vitamin B1;

With achalasia, a person will be bothered by dull pain behind the chest that radiates to the back, as well as frequent nausea.

5. Sometimes the esophagus hurts due to disruption of the nervous system. This is due to the fact that several cranial nerves are responsible for the functionality of this organ, which cause its relaxation. With strong emotional outbursts, this balance is disrupted, which provokes spasms and pain in the esophagus.

It is also important to know that an unstable psycho-emotional state of a person can provoke various diseases of the digestive system (ulcers, pancreatitis) and the cardiovascular system (heart attack, hypertension, tachycardia, arrhythmia, etc.).

Symptoms

In the vast majority of cases, pain when swallowing localized in the chest is the first clinical manifestation indicating the development of a particular disease.

The specificity of this symptom lies in its focus - very often people perceive pain in the sternum as a symptom of cardiovascular pathologies. In this case, patients seek help from a cardiologist and undergo unnecessary diagnostic measures. At this time, a completely different disease progresses in the body.

The most common symptoms that complement the clinical picture that it is painful for a person to swallow are:

• belching and heartburn;
• burning and discomfort in the chest area;
• irradiation of pain to the area between the shoulder blades and the heart. Several times less common is the spread of pain to the back and upper limbs, jaw and ears;
• disruption of the process of swallowing food ingredients - with minor damage to the esophagus, dysphagia is associated only with solid food, but as the situation worsens, even liquid cannot pass through the esophageal tube, which can lead to exhaustion;
• acquisition of a permanent character by the main feature and its significant strengthening in the process of food consumption;
• cough and sore throat;
• pathological redness of the face;
• increased gas formation and salivation;
• attacks of nausea and vomiting. Sometimes the presence of pathological impurities, for example, blood, may be observed in the vomit;
• stool disorder - most often patients complain of constipation, less often of diarrhea or alternation of similar manifestations;
• increased body temperature;
• prolonged fever;
• discomfort in the epigastric region;
• aversion to food - very often this happens in relation to fatty foods, meat and dairy products;
• shortness of breath - along with pain in the heart area forces people to consult not a gastroenterologist, but a cardiologist.

The above symptoms do not mean at all that the clinical picture will be limited only to such signs. Depending on the etiological factor, some of them may fade into the background.

Pain in the esophagus: features and causes

When pain in the esophagus begins to bother you, you need to know the reasons for its occurrence. If you don't pay attention to this, there can be serious consequences.

As you know, the esophagus is a part of the digestive tract, which looks like a hollow muscular tube connecting the pharynx and stomach. Usually this is the least problematic organ of the gastrointestinal tract, since it does not retain, digest or adsorb food, but only promotes its movement through peristaltic muscle contractions.

The adult human organ is 25-30 cm long and consists of several layers:

• internal mucosa;
• submucosa;
• muscle layer;
• connective tissue membrane.

The main symptom of esophageal disease is pain. It usually manifests itself in the form of burning, discomfort or acute pain (in case of serious injuries and illnesses). It is mainly localized behind the sternum (on both sides or selectively on the right or left), and can radiate to the back, interscapular region, left arm (simulating angina), upper neck and even lower jaw.

More often, pain is associated with eating, less often it occurs spontaneously and for no apparent reason.

Main causes of pain in the esophagus

Damage to integrity is the main visible cause of pain. It can be external and internal.

External are visible penetrating wounds of the chest, and internal are divided into several types.

1. Damage to the inner layer, mucous membrane and muscle layer after swallowing sharp objects (needles, nails, blades). There may also be other foreign bodies (objects of round and flat shape, the size of which coincides with the diameter of the esophageal cavity). In this case, the pain is localized behind the sternum and intensifies when swallowing. Foreign bodies are often found in children, as well as in adults, due to inattention and haste while eating. Such items can be mainly fish and meat bones.
2. Perforation or disruption of the integrity of the wall of a hollow organ. Occurs as a result of various types of burns, including chemical ones, in addition, after trophic ulcers, breakdown of cells and tissues of a tumor neoplasm. Perforation is accompanied by sharp increasing pain, intensifying with any stress on the smooth muscles, internal bleeding and even bloody vomiting.
3. Burns. They occur when consuming various chemicals and substances, acids, and alkalis in concentrated form. The pain itself has its own characteristics depending on the type of chemical substance; it spreads throughout the oral cavity, pharynx, esophagus and even extends to the stomach.
4. Esophagitis is inflammation of the inner wall of the esophagus. Peptic esophagitis (or reflux esophagitis) occurs when the contents of the stomach (gastric juice) and/or the contents of the duodenum (pancreatic secretion and bile) involuntarily reflux into the esophagus. It is mainly accompanied by a temporary burning sensation, heartburn, discomfort, and mild pain that occurs under the xiphoid process and sometimes radiates to the back and upper neck.
5. Hiatal hernia. Most often it forms at the site of the diaphragmatic narrowing of the esophagus; pain manifests itself when overeating and taking a horizontal position. The character resembles the pain characteristic of angina pectoris, but varies in intensity and duration. Sometimes it can go to the left hand.
6. Tumors of the esophagus. Most often, pain appears in advanced cases, depending on the location and nature of the tumor; it can manifest itself either as constant aching pain and pressure in the esophagus, or imitate pain in nearby organs, for example, in the stomach.
7. Esophageal ulcer. The pain that occurs with an ulcer can occur both at rest and during swallowing. It mainly intensifies when eating foods of contrasting temperatures and foods with high acidity. The sensations themselves are similar to a heart attack.
8. Erosion of the esophagus. Characterized by dull or sharp chest pain and colic in the abdominal cavity. It can spread to various parts of nearby organs.

Some features

Pain when swallowing (odynophagia) can occur with inflammatory diseases or muscle spasms of the esophageal sphincters. Spasms of the esophagus itself are most often a disorder of the nervous system, manifested by unpleasant sensations during swallowing and a feeling of compression of the walls of the esophagus. Shortness of breath is often possible.

A special niche of diseases, due to the absence of pronounced pathologies, is occupied by achalasia of the cardia, in which the cardiac sphincter, located in the area where the esophagus passes through the diaphragm, ceases to open reflexively. In this case, food delays occur, accompanied by a feeling of fullness. The chest pain itself is combined with pain in the interscapular region and belching.

And the pain that occurs as a result of dyskinesia (impaired motor function) has a special character. They are mainly localized behind the sternum and occur after swallowing large pieces of food, consuming hot and cold foods, and alcohol-containing drinks.

The pain spreads to the back, neck and submandibular region.

In advanced cases, symptoms include fever throughout the body, sweating and even trembling.

Diagnostic methods

Diagnosis of diseases of the esophagus is the main and main factor for a speedy recovery and prescribing the correct treatment. Today it is carried out using the following methods:

1. Contrast fluoroscopy of the esophagus. It is performed by using a radiopaque substance and allows you to determine the condition of the walls of the esophagus and the presence of a defect in them.
2. Esophagomanometry. This is a method used to diagnose dyskinesia of any kind. It is carried out by changing the partial pressure on different areas of the esophagus.
3. Esophagoscopy. An instrumental research method in which, under the control of an endoscope, it is possible to examine the esophageal mucosa and determine the presence of an ulcer or erosion.
4. CT scan. Most often it is performed if there is a suspicion of the presence of tumor-like formations.

Correct treatment

The main stage of treatment is to determine the causes of disruption of the esophagus and its tissues. Therefore, you should avoid self-medication and if you have any complaints or questions, immediately contact a specialist (gastroenterologist or therapist). And only based on the results of the examination and identification of the causes, treatment will be prescribed. Remember that it is important to take timely measures and act not on the symptoms, but on the source of the disease itself.

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Please note that:

1. For diseases that occur as a result of nervous disorders, you should avoid severe stress and high physical activity. In addition, it is necessary to observe a work and rest schedule.
2. If there are pathologies caused by an acute disruption in the functioning of organs, you should resort to urgent surgical care in a hospital.
3. In case of chronic, indolent diseases with mild symptoms, it is necessary to minimize the impact of harmful factors.
4. If the functioning of neighboring organs is disrupted, their immediate treatment is required.

Often, a diet is prescribed as a treatment, recommendations are given on the frequency of food intake, its quantity and even cooking features. Spa treatment may be prescribed, with electrophoresis being preferred among physiotherapy.

The main thing you shouldn’t do is ignore the symptoms of the disease and drown out the discomfort with various painkillers. You should not use traditional methods of treatment without consulting a doctor.

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Remember that any drug treatment is prescribed by a doctor after receiving the results of the examination and necessary tests. Follow the recommendations and be healthy!

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Diagnostics

To find out the causes of chest pain, it is necessary to carry out a whole range of diagnostic measures. Thus, a comprehensive diagnosis is presented:

• studying the patient's medical history;
• collecting a person’s life history;
• a thorough physical examination;
• a detailed survey of the patient - to determine the severity of the main manifestation and the presence of additional signs;
• general blood and urine analysis;
• microscopic studies of feces;
• magometry and fluoroscopy;
• esophagoscopy and gastroscopy;
• biopsy and daily pH-metry;

Only after studying the results of all diagnostic procedures does the clinician draw up an individual treatment strategy for the disease that has caused pain when swallowing in the middle of the chest.

Infectious lesions

Also, the cause of a lump in the throat and pain in the sternum can be infectious and bacterial infections of the upper respiratory tract. This can be acute/chronic tonsillitis, laryngitis, or more severe diseases. These include:

• Measles.
• Scarlet fever.
• Diphtheria.
• False croup.

The primary history of the listed diseases can manifest itself in the form of discomfort, sore throat, headache and chest pain. The next stage in the development of the disease is chills, fever, and with some diseases (measles, scarlet fever) a red rash appears on the body.

At this point in time, these pathological processes can be easily cured with antibiotics. The risk of complications from the disease is extremely small.

Those who do not react to the discomfort that appears, when they “cannot” endure the pain, in a timely manner will spend much more time on treatment. After all, mostly a lump in the throat and chest pain are signs of an onset of the disease. And treatment in the first stages is more effective.

Treatment

Despite the wide variety of predisposing factors, therapy for chest pain when swallowing food can be relieved using the following basic techniques:

• taking medications - these can be painkillers, sedatives, calcium antagonists, antacids, tonic drugs and medications aimed at eliminating additional symptoms;
• physiotherapeutic procedures, in particular, medicinal electrophoresis;
• maintaining a gentle diet is indicated for absolutely all patients with gastrointestinal pathologies;
• expansion of the esophagus by bougienage;
• excision of malignant or benign neoplasms;
• chemotherapy;
• the use of traditional medicine recipes is carried out under the strict supervision of the attending physician.

In any case, the question of using one or another therapy technique is decided individually with each patient.

Treatment of pain in the esophagus

Having identified the underlying cause, the doctor will prescribe treatment. It will depend on the disease and clinical picture. To combat individual symptoms, you can use medications, folk remedies and diet.

For achalasia, when food gets stuck in the esophagus, nitrates, antacids, and calcium antagonists are used. If drug treatment is ineffective, cardiodilation, dilation of the esophagus by installing a special balloon in its lumen, is indicated.

Reflux esophagitis - a diet must be prescribed, antacids are indicated - Maalox, Phosphalugel, histamine receptor blockers - Ranitidine, flax seed decoction, Cerucal, Famotidine, Cisapride.

Hiatal hernia - treated with diet and physical therapy. To eliminate symptoms, heartburn medications and antacids are prescribed.

Medications

To relieve pain and eliminate the inflammatory process, medications such as Almagel, Gastrozol, Gaviscon, Gastracid, Almol, Acrilanz can be used.

The following groups of drugs are used for treatment:

• prokinetics - Motilium and Motilak, help normalize the function of the esophageal sphincter;
• antisecretory agents - Omeprazole, Famotidine, inhibit acid production;
• antacids - Almagel, reduce the acidity of gastric juice, are prescribed for severe pain attacks.

The drugs can be prescribed for a single dose when heartburn and pain occur, or for a course of 7 days or more. Drug therapy must be supplemented by diet. You don’t have to greatly limit yourself in food; you can eat all the same foods, but in small portions. It will be necessary to exclude only peppery, hot, sour and hot foods.

Folk remedies

Traditional medicine recipes can relieve symptoms such as heartburn, belching, and the sensation of a lump in the throat. They can be used after examination by a doctor.

For achalasia, you can use an infusion of marshmallow root, decoctions of ginseng, lemongrass, and pink radiola extracts. These funds can also be used for prevention.

For esophagitis, decoctions of oak bark, St. John's wort, oregano will be useful. You can add walnuts, honey, and cinquefoil rhizomes to the product. To reduce swelling of the mucous membrane, a mixture of alder catkins, burnet and oregano is used. A decoction of the collection is taken a teaspoon several times a day.

For heartburn, you can prepare an infusion of calamus root and a decoction of mulberry leaves. Oregano oil will also relieve the symptom. It should be taken 3 times a day, 2 drops, diluted in water. Oregano oil can be inhaled, which will also help relieve heartburn.

Prevention and prognosis

To prevent pain when swallowing, in particular during eating, no specific preventive measures have been developed. However, people are advised to follow a number of simple general rules. These include:

• maintaining an active and healthy lifestyle;
• avoiding emotional and physical fatigue;
• drawing up a correct, balanced and enriched diet with all the substances necessary for the body;
• using only those medications prescribed by the attending physician - with strict adherence to the daily dosage and duration of therapy;
• if possible, avoid injury to the esophagus from the outside or foreign objects;
• undergo a full preventive examination at a medical institution several times a year with a mandatory visit to a gastroenterologist.

The outcome of chest pain when swallowing directly depends on the disease that provoked it. However, since they are a specific symptom that forces a person to see a doctor, treatment often begins in a timely manner, which gives a positive prognosis. However, we should not forget that each etiological factor has its own complications.

In the chest area there are the esophagus, heart, lungs, as well as many nerve endings, cartilage, and blood vessels. This is where the ribs are located. If any of these elements are damaged or inflamed, chest pain may appear after eating, at night, upon awakening, and in other cases. Sometimes the symptoms are severe and cause significant discomfort to the patient.

When help is needed urgently

The chest and throat area are complex structures in which a lot of organs important for normal functioning are concentrated. Patients are advised to consult a doctor at the first appearance of negative symptoms, even if it is a combination of chest pain and sore throat.

A timely visit to a doctor will help to diagnose the disease in time and begin its treatment. It is important to prevent the chronicization of pathological processes or their transition to more aggressive stages (for example, the transition of angina to myocardial infarction or the transition of gastritis to a stomach ulcer, etc.).

A timely visit to a specialist will save the patient from many problems in the future and will help preserve not only health, but often life, since a number of reasons that cause the appearance of symptoms are life-threatening conditions that pose a real danger.

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Additional symptoms that cause pain when swallowing

In a healthy person, chest pain may appear due to overeating or food habits, but it goes away quickly and is not accompanied by additional symptoms. If pain located in the center, behind the sternum or closer to the surface, is accompanied by other signs, you should think about the presence of pathology.

• pain appears often, radiates to the area of ​​the heart or shoulder blades, upper limbs;
• problems with the swallowing process are caused by deformation of the esophagus, the appearance of ulcers and inflammation;
• the patient suffers from burning and discomfort in the chest space, heartburn and belching appear;
• often itchy throat, coughing;
• pain intensifies while eating;
• vomiting, nausea, and epigastric discomfort often occur;
• Fever often develops and body temperature rises;
• against the background of pain when swallowing, an aversion to fatty foods and meat may develop.

There are other symptoms associated with digestion: stool disorders, gas formation, excessive salivation. Due to pain and discomfort, a person may experience pathological redness of the face, shortness of breath, and sweating.

Causes of discomfort when swallowing

Today, doctors identify a number of diseases that can lead to a person developing such complaints as chest and throat pain. Often this seemingly identical symptom is a consequence of the progression of pathological processes in the body that are completely different in patients.

Doctors also remind you that often the most ordinary stress becomes the cause of an unpleasant feeling. People prone to overly intense emotional reactions often suffer from chest and throat pain after outbreaks.

However, it makes sense to attribute such a reaction to emotions only if the attack of pain was isolated and developed precisely against the background of an emotional reaction. If a symptom appears spontaneously or under the influence of other provoking factors, you should consult a doctor and try to find its causes.

Chest pain is often associated in patients with various pathologies of the cardiovascular system, which cannot be said about pain in the throat. However, when a patient experiences chest pain, he does not think about his sore throat and immediately begins to panic.

Angina develops when the heart muscle does not receive enough oxygen to function fully. Oxygen starvation explains the localization of the main pain.

Without comprehensive timely treatment, angina often develops into myocardial infarction.

In addition to angina, myocarditis can cause pain in the chest and throat. With this pathology, inflammation of the heart muscle develops, formed against the background of an autoimmune or infectious process.

Atherosclerosis of blood vessels is another disease that leads to pain in the chest and throat. The mechanism of pain is similar to the mechanism that works with angina pectoris: the heart muscle does not receive enough blood, and with it, oxygen.

Various pathological changes in the respiratory system are another reason that can cause symptoms such as pain in the throat and chest. Often, in addition to pain, other signs of pathology appear, such as fever, chills, weakness, and the inability to fully inhale or exhale.

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It is worth noting that the lungs do not have pain receptors, and therefore it is worth talking about pain in the chest due to lung disease only when the pleura is involved in the pathological process. This can happen, for example, with pleurisy or pneumonia of various etiologies.

Pneumonia, like pleurisy, is accompanied by symptoms characteristic of any respiratory disease, and pain in the chest or throat is far from the main one of these symptoms.

Pain in the chest area can also cause various pathologies of the pulmonary vessels. For example, with an embolism that develops as a result of prolonged immobility, the patient will feel a burning sensation that bothers him not only in the chest area, but also, possibly, in the throat.

Soreness in the chest and throat is often a consequence of various pathological processes affecting the digestive organs. Many patients mistakenly believe that digestion begins only in the stomach, but this is not true.

One of the first reasons leading to the appearance of pain behind the sternum or in the throat area is esophagospasm. In this case, the functioning of the esophagus is disrupted, its muscles spasm, causing burning pain to the person. A spasm can be triggered by physical activity, uncomfortable body position during sleep, too spicy food and many other factors.

The symptoms of esophagospasm often resemble an angina attack. Pain with this pathology, as with angina, often radiates to the area of ​​the shoulder blade, throat, and lower jaw. Sometimes esophagospasm is accompanied by the reflux of liquid food from the stomach into the esophagus, which leads to a burning sensation.

A hiatal hernia is another pathology that can lead to soreness behind the breastbone or in the throat. In addition to diseases of the esophagus, one cannot exclude the development of gastritis, gastric ulcers, heartburn attacks, and gastroesophageal reflux in the patient.

All of these diseases have a similar set of symptoms, and therefore the patient needs a thorough diagnosis to establish the cause of the complaints.

Neurology

Neurological pathologies and various diseases of the joints in the spinal column are another reason that can lead to pain in the chest and throat. The main disease that causes these unpleasant symptoms is intercostal neuralgia.

Intercostal neuralgia is often confused by patients with angina or myocardial infarction. In the meantime, these pathologies should not be confused, as this can be life-threatening. You can prove the presence of neuralgia, and not a heart attack, by asking the patient to change position.

Often, unpleasant sensations in the chest and throat area appear due to various hernial protrusions. Pain can be caused mainly by hernias of the cervical spine, but problems in other parts can also contribute to the appearance of an unpleasant symptom in the patient.

Injuries of various origins are another common cause of pain in the throat or behind the sternum. In general, trauma is the easiest to identify as a trigger for the onset of a symptom, since the patient can specifically tell when he encountered the trigger and under what circumstances it happened.

Any injuries received in the chest area (rib fractures, rupture of the lung or esophagus, etc.) can lead to acute pain not only in the sternum, but also in the throat. Timely diagnosis of injury will help you choose the right treatment and begin therapeutic measures.

What does chest pain mean?

The most common cause of pain in the throat when swallowing is pharyngitis - an inflammatory process in the pharynx. This is the most common form of sore throat, the development of which occurs after ARVI. Its peculiarity is severe pain in the throat when swallowing.

When a person swallows food or water, he does it automatically, without even thinking about it. In fact, the act of swallowing is a coordinated effort between the jaws, esophagus and throat. A complex system of muscles is involved in swallowing.

The pain in the throat is truly excruciating - it is accompanied by a burning sensation in the back of the throat. This causes increased sensitivity in the neck. When the throat hurts, a person may experience enlargement of the submandibular lymph nodes, chills, and cough.

Also, pain in the throat when swallowing can occur in combination with pain in the chest.

To determine the exact cause of pain in the throat and chest after a cold, you should consult a doctor and do not delay so that treatment is faster and more effective.

Causes of chest pain when swallowing

Soreness can be caused by infectious pathologies, the symptoms will be classic: fever, sore throat, runny nose. The situation is different with diseases of the esophagus, which differ significantly from viruses and infections.

Esophageal injuries

Injuries can occur due to puncture and cutting wounds, gunshot wounds and other injuries. Injuries can be caused by pathological processes: neoplasms, narrowings, dilations, damage to large vessels. Doctors can also injure the esophagus during surgery.

Symptoms of esophageal injury include:

• pronounced odor from the mouth;
• cough and shortness of breath, difficulty breathing;
• heartburn, burning sensation in the chest;
• sharp pain behind the sternum when swallowing and at rest;
• decreased blood pressure;
• decline of immunity, gastrointestinal diseases;
• pallor, blue discoloration of mucous membranes.

The most pronounced symptom of esophageal injury is the inability to swallow.

Esophageal diverticulitis

Zenker's diverticulum is a hernia-like distension in which food can get stuck when swallowing. This makes your chest hurt when you swallow. Zenker's diverticulum is located in the sphincter area. The pathology appears mainly in patients over 50 years of age. Men suffer from it more often than women, especially if they have ulcers or gastritis.

The first symptoms of diverticulitis include a sore throat, an unpleasant odor, and a constant sensation as if there is food stuck in the throat. Gradually, the patient refuses to eat, which is why he loses weight and his immunity deteriorates.

Diverticulitis can only be treated with surgery followed by dietary restriction. The patient is shown how to eat food correctly. If pathology is detected at an early stage, rinsing may be prescribed. If the pathology is not treated, it is complicated by suppuration, pneumonia, ulcerative processes and perforation.

Esophagospasm

With this disease, the motility of the esophagus is impaired due to severe spasms caused by excitement, drinking or eating. There are 2 forms:

• primary esophagospasm - appears due to diseases of the nerve endings;
• secondary – develops with damage to the mucous membranes.

Chest pain appears both when eating and during the day. Patients often wake up with pain at night. This disorder can be provoked by factors such as insufficient chewing of food, too spicy and hot food, the habit of eating on the go and eating dry food.

Cardiospasm

With this disorder, a change occurs in the lower part of the esophagus - first it sharply narrows, then expands. Provoke pathology:

• roughage;
• parasitic infestations;
• anemia;
• avitaminosis.

Chest pain with cardiospasm appears due to stagnation of food in the esophagus. The pain goes away as soon as the food moves into the stomach. However, without treatment, food retention becomes permanent, causing severe vomiting and belching. Often develops against the background of tumors of the lower esophagus.

Esophagitis

Unlike the two previous pathologies, esophagitis is accompanied by constant inflammation of the mucous membrane, as with gastritis. Only it is not the stomach that suffers, but the esophagus. It can be chronic, acute and subacute.

CHAPTER 4. CHEST PAIN CAUSED BY ESOPHAGUS DISEASES

1. In what cases may a doctor suspect that chest pain is caused by diseases of the esophagus?

In developed countries, coronary heart disease is a very common disease. In the United States, 1.5 million people develop myocardial infarction each year, accounting for 25% of all deaths. Diseases of the esophagus are also quite common. However, chest pain caused by diseases of the esophagus is rarely life-threatening and does not require immediate diagnosis. Therefore, first of all, in patients with chest pain, it is necessary to exclude coronary heart disease. The absence of changes in the electrocardiogram during a painful attack can to some extent reassure the doctor. But in case of severe pain attacks, the patient must be hospitalized. In the hospital, he undergoes serial ECG recordings and determines the level of cardiac-specific enzymes. Further tests ordered after the acute period include an exercise test, thallium exercise test, or coronary angiography. Since the exercise test produces false-positive results in 34% of cases, only the latter two methods can confidently exclude coronary heart disease. At this stage of the examination, it is possible to associate chest pain with diseases of the esophagus. The concept of esophageal origin of chest pain is not new. 100 years ago, William Osier suggested that esophageal spasm was one of the causes of chest pain in soldiers during war.

2. Does ruling out coronary heart disease mean all heart diseases?

Of course not. Patients with chest pain may have cardiac lesions that are not associated with coronary artery disease, such as mitral valve prolapse and angina caused by microcirculatory disorders. To exclude mitral valve prolapse, echocardiography is required, while to exclude myocardial microvascular damage, it is necessary to perform a rather complex study consisting of measuring coronary artery resistance during ergonovine stimulation and rapid atrial contractions. However, some studies suggest that pain occurs no more often in patients with mitral valve prolapse and damage to the myocardial microvasculature than in the rest of the population; therefore, the question of whether this pathology is the cause of pain development remains open. Even if these diseases lead to chest pain, the mechanism is not clear. Moreover, the prognosis for these diseases is favorable, and mortality does not exceed that in the rest of the population. Finally, the combination of the above pathology with impaired motor function of the esophagus suggests that these diseases have a common cause - either a generalized smooth muscle defect or increased visceral nociception. That's why it makes sense to prioritize research to identify diseases of the esophagus that are more common and more treatable.

3. Does taking an anamnesis help in the differential diagnosis of chest pain caused by diseases of the esophagus and heart?

Yes and no. Acute pain localized at one point - in the fifth intercostal space along the midclavicular line, occurring in women over 20 years of age, is unlikely to be associated with coronary heart disease. Some features of the course of the disease make it possible to clearly distinguish the causes of pain. However, many studies indicate common clinical manifestations in various diseases; therefore, diagnosis cannot be made based on symptoms alone. The description of a painful attack by some patients with known esophageal disease and no heart disease closely mimics the classic description of an attack of angina, including pain on exercise. According to the results of one study (Belgium), 25% of patients diagnosed with coronary heart disease based on the clinical picture and observed by cardiologists had completely normal coronary angiograms. In half of these patients, the cause of pain may be esophageal diseases that need to be diagnosed.

4. Name the causes of chest pain that are not caused by heart disease. How often do they occur?

Gastroesophageal reflux is one of the most common causes of chest pain associated with damage to the esophagus. (According to most studies, more than 50% of cases of chest pain of unknown origin are caused by gastroesophageal reflux.) Impaired motor function of the esophagus is diagnosed in more than 25-30% of patients with chest pain. Of the remaining 20-30% of patients, in one third to half, pain can be explained by musculoskeletal disorders such as osteochondritis (Tietze syndrome) and chest wall pathology. As will be discussed below, mental disorders (as independent or concomitant causes) should also be considered in the differential diagnosis. In particular, panic conditions can act as a cause for the development of pain syndrome.

The diagram shows the various causes of chest pain of unknown origin and their percentage

5. Since gastroesophageal reflux is a common cause of unexplained chest pain, should such patients undergo a therapeutic test to reduce gastric acidity?

This therapeutic test is relatively inexpensive, easy to perform, and avoids further testing. However, it is necessary to use adequate doses of appropriate drugs. The current recommendation is omeprazole 20 mg twice daily or lansoprazole 30 mg twice daily for 4 to 8 weeks. The test can give both false positive and false negative results. Recently published studies have described the unresponsiveness of some patients to omeprazole, used in recommended doses, which led to a decrease in hydrochloric acid secretion. It is suggested that in such patients gastroesophageal reflux is not the cause of pain. However, a final conclusion is impossible without ambulatory monitoring of the pH of the contents of the stomach and esophagus while taking omeprazole. A false-positive result may occur with the placebo effect, especially in patients with unexplained chest pain. In one study, a placebo effect was observed in 36% of patients with suspected esophageal pain.

6. Which examination of the esophagus is the most informative?

Gastroesophageal reflux is the most common cause of chest pain of unknown origin, so this diagnosis should be assumed first. Monitoring the pH of the esophageal contents on an outpatient basis is the most informative test in the diagnosis of gastroesophageal reflux and the test that most often gives a positive result in patients with chest pain of unknown origin. For the reasons stated above, this study is justified even if the test with drugs that reduce the acidity of gastric juice turns out to be negative. If outpatient monitoring reveals a deviation in esophageal pH from normal (in particular, a decrease), esophagogastroduodenoscopy (EGD) is performed to rule out more severe consequences of gastroesophageal reflux, such as esophagitis and Barrett's esophagus. Performing endoscopy is indicated in cases where the total acidity in the esophagus over a 24-hour period exceeds the norm by 10% or even with a slight increase in the level of basal secretion. If ambulatory monitoring of the pH of the esophageal contents gives a negative result, a study is carried out aimed at identifying disturbances in the motor activity of the esophagus. Chest pain of unknown origin > Rule out cardiac disease (epicardial vascular disease) > Study with drugs that suppress the secretion of hydrochloric acid > Monitor esophageal pH* > Basal manometry and provocative tests > (Bernstein, with edrophonium, balloon dilatation of the esophagus) > Discussion of other possibilities reasons

*Endoscopy is indicated if signs of severe reflux of gastric contents into the esophagus are detected when monitoring the pH of the esophagus (see text). Other, more rare causes of chest pain have been described, such as diseases of the biliary tract and peptic ulcer of the stomach or duodenum. Therefore, further investigations of the digestive tract, including ultrasound scanning of the abdominal organs, are necessary, especially if the patient's medical history suggests these diagnoses.

7. How is a monitoring study of esophageal pH carried out?

A monitoring study of esophageal pH is carried out in the morning on an empty stomach. The acidity level is determined using an intraesophageal glass or antimony electrode. Typically, the electrode is placed 5 cm above the superior edge of the lower esophageal sphincter (as previously described for esophageal manometry). The antimony electrode is thinner (its diameter is 2 mm), but requires the use of a reference (control) silver or silver chloride electrode (the so-called reference electrode) applied to the patient’s chest. The main electrode is inserted intranasally. The pH level of the esophagus is determined for at least 16 hours. The patient can adhere to his usual daily routine. Study data is recorded in a portable sensor with “marker” buttons, which allows the patient to note the time of eating, resting in a lying position, and the onset of symptoms. The patient's diary also indicates the time when certain events occurred. All information is entered into a computer the next day and analyzed both visually and using special computer processing methods.

8. What changes can be detected when monitoring esophageal pH?

Analysis of the study results includes the duration of acid exposure, i.e., contact of the esophageal mucosa with acidic gastric contents (for example, the duration of the period when the pH of the esophagus 4),

and its relationship to the occurrence of symptoms.
An objective diagnosis of gastroesophageal reflux is made in cases where the pH in the lower esophagus is reduced throughout the study or if the acid exposure in the standing and lying positions exceeds 95% of normal values. According to our study, the time during which pH < 4 is recorded should not exceed 4.2% of the total research time, 6.3% of the time spent in a vertical position, and 1.2% of the time spent in a lying position. Although it is known that with a certain degree of reflux of acidic gastric contents into the esophagus, the patient may experience characteristic clinical symptoms, these are not proof of the presence of gastroesophageal reflux. For this reason, the assessment of symptoms during the study is far from straightforward. If the occurrence of all clinical symptoms corresponds in time to episodes of reflux of acidic gastric contents into the esophagus, then the diagnosis of gastroesophageal reflux can be made even when the absolute value of acid exposure does not exceed 95% of normal. The lack of correlation between episodes of reflux and the occurrence of clinical symptoms does not support the diagnosis of gastroesophageal reflux. The situation seems more complicated when only some clinical symptoms coincide in time with episodes of reflux of acidic gastric contents into the esophagus. Various so-called “symptom indices” are used to quantify the relationship between reflux and symptoms. The simplest index is the ratio of the total number of symptoms to the symptoms that occur during acid reflux. Symptom Index = Number of symptoms occurring during reflux / Total number of symptoms during esophageal pH monitoring
If the index value is 50% or more (ie, if two out of four symptoms occur during an episode of reflux), the test is considered positive. The approach to treating reflux-induced chest pain is no different from that for established gastroesophageal reflux (see Chapter 2).

Result obtained from 4-hour monitoring of esophageal pH. During this period, 2 of the 4 symptoms (R) appeared concurrently with episodes of acid reflux; symptom index was 2/4, 50%

9. What disorders of the motor function of the esophagus are detected in patients suffering from chest pain if the diagnosis of gastroesophageal reflux is excluded?

Disturbances in the motor function of the esophagus are the cause of the development of pain in 25-30% of patients with chest pain of unknown origin. They can be divided into the following types: Nutcracker esophagus

- the most frequently detected pathology during esophageal manometry.
The disease received such a unique name due to the fact that during peristalsis of the esophagus, the pressure in it reaches very high values. The diagnosis is made if the average amplitude of peristaltic waves in the distal parts of the esophagus exceeds 180 mm Hg. Art. during 10 acts of swallowing (when swallowing liquid). Nonspecific esophageal motility disorders
are the second most common change detected during esophageal manometry . With this disease, patients experience weak peristaltic waves that poorly push the bolus of food into the stomach.

Nutcracker esophagus. The average amplitude of peristaltic waves in this patient is 250 mmHg. Art. She experiences pain with almost every act of swallowing

Diffuse spasm of the esophagus. In response to swallowing water, both combined (S) and peristaltic (P) contractions occur

Diffuse spasm of the esophagus

It is diagnosed when, with at least 2-10 acts of swallowing water, instead of normal peristalsis, simultaneous contraction of many muscle fibers occurs.
At the same time, other disorders are sometimes recorded, for example, multiple (multi-peak) or prolonged muscle contractions. This mechanism of impaired motor activity of the esophagus is often assumed, but during esophageal manometry it is recorded in only 10% of patients with chest pain. Pathologically high basal lower esophageal sphincter pressure
may also be associated with chest pain.
Esophageal achalasia
sometimes presents with chest pain. (See Chapter 5 for more details.) The relative frequency of detection of all of the above changes is illustrated in the diagram.

Possible diagnoses in patients with esophageal motor dysfunction leading to chest pain.

10. What is the relationship between esophageal motor dysfunction and chest pain?

The mechanisms that lead to chest pain due to impaired motor function of the esophagus are currently not well understood. It has been proven that there are specific mechanoreceptors in the mucous membrane and submucosal layer of the esophagus. Pathological contractions of the esophageal wall can irritate these receptors and cause pain. In addition, stimulation of the receptors can occur when the walls of the esophagus are stretched due to impaired relaxation of the lower esophageal sphincter or the accumulation of food masses in the esophagus. Another possible cause of pain is a change in the sensitivity threshold of the esophagus, which seems to “tune” the patient to changes in esophageal pressure. The last mechanism is that stretching the walls of the esophagus adversely affects its blood supply, leading to the development of muscle ischemia. However, the esophagus is well supplied with blood, and the duration of its contractions is clearly insufficient for the development of ischemia. It is possible that disturbances in the motor activity of the esophagus are not the cause of pain. It can be assumed that there is an epiphenomenon - another, unknown disease that causes chest pain.

11. What are esophageal provocation tests?

In the presence of gastroesophageal reflux, identifying disturbances in the motor activity of the esophagus does not at all prove that they are the cause of the pain. Sometimes, during routine esophageal manometry, patients experience pain associated with pathological contractions of the esophagus. However, in most cases the disease does not manifest itself clinically. There are additional measures, similar to the exercise test in cardiology, that can stimulate the functions of the esophagus and provoke the onset of clinical symptoms. These include esophageal acid injection, pharmacologic stimulation, and esophageal balloon distension. For many years, gastroesophageal reflux was thought to cause pain because it caused problems with esophageal motility. Although this theory has not been confirmed, the test with the introduction of acid into the esophagus (Bernstein test) is still used in the clinic for the differential diagnosis of chest pain of unknown origin. Usually, 60-80 ml of 0.1 N hydrochloric acid solution is first injected into the esophagus at a rate of 6-8 ml/min (the patient is not informed about this), and then approximately the same volume of isotonic sodium chloride solution. The test is considered positive only if (1) the patient experiences typical clinical symptoms during acid administration and (2) the symptoms disappear or do not recur when an isotonic sodium chloride solution is injected into the esophagus. There are chemoreceptors in the mucous membrane of the esophagus. Patients with a positive Bernstein test (chemoreceptor acid sensitivity) should be treated as patients with gastroesophageal reflux. For diagnostic purposes, various pharmacological drugs are also used to stimulate the functions of the smooth muscles of the esophagus. The cholinesterase inhibitor edrophonium (80 mcg/kg intravenously) is currently used for this purpose. After administration of edrophonium, even in completely healthy people, a response of the smooth muscles of the esophageal wall develops: the amplitude and duration of peristaltic waves during the act of swallowing sharply increase. The test is considered positive only if at the time of testing the patient develops a typical pain attack. Intraesophageal balloon dilatation is a measured stretching of the walls of the esophagus with a balloon gradually increasing in size until pain appears or the expected maximum volume is reached. The test is specific; the mechanism of pain does not differ from that in cases of impaired motor function of the esophagus. The test is considered positive if the patient experiences a typical pain attack upon reaching a balloon volume that does not cause discomfort in healthy people. Esophageal balloon dilatation is the most widely used provocative test. Of the three tests listed, acid administration and edrophonium usually lead to clinical symptoms in 20% of cases, with balloon dilation of the esophagus this figure is twice as high.

The charts show data from seven studies that determined the incidence of pain in response to balloon dilatation of the esophagus, edrophonium and acid in patients with unexplained chest pain

12. Compare the effectiveness of provocative tests with ambulatory monitoring of motor activity and esophageal pH.

All esophageal provocation tests have one big drawback - they are not physiological. Attempts have been made to conduct long-term manometry of the esophagus in order to record changes in its motor activity during spontaneous attacks of chest pain. Modern technical advances make it possible to perform esophageal manometry for 24 hours or more with minimal disturbance to the patient. Such studies provide a large amount of information. To date, however, it is not clear which of these methods is the best. In addition, whatever method is used, a comparative analysis of the results obtained during symptomatic and asymptomatic periods is always necessary. Although long-term ambulatory manometry and esophageal pH testing have established a physiological relationship between pain and esophageal motility disorders, the effectiveness of this method is no greater than that of provocative tests performed in many laboratories. Physicians with extensive experience in outpatient monitoring of motor activity and esophageal pH suggest that it should be used to clarify the cause of chest pain if provoking tests have given positive results.

13. What is visceral hypersensitivity? Define the term “irritable esophagus.”

Many patients with unexplained chest pain experience a lower pain threshold during balloon esophageal dilation than healthy people. This is thought to be due to visceral hypersensitivity or damage to nociceptive mechanisms. In some patients, this condition may be caused by pathological contractions of the esophagus, but to a greater extent by disruption of the receptor perception of normal stimuli, including muscle peristaltic contractions, acid reflux within physiological limits, and distension of the esophageal wall by air or food. pH monitoring in combination with esophageal manometry can identify patients who are hypersensitive to both acid irritation of the esophageal mucosa and contractions of the esophageal wall. This condition is described in the literature under the name “irritable esophagus.” When examining such patients, an increase in potential stimulation of the esophagus by impulses coming from the brain is revealed, and therefore it has been suggested that both central and peripheral pain reception are impaired.

14. Does the psychological component play any role in the occurrence of chest pain of unknown origin?

All diseases have a psychological component, since any disease is superimposed on the patient’s personal perception and his previous life experiences. All this is also true for chest pain of unknown origin. Various psychological disorders are found in 43-59% of patients with chest pain caused by the reasons described above. Patients with esophageal motor dysfunction may also have various mental disorders (according to one study, in 84% of cases). Therefore, when treating chest pain of unknown origin, it is necessary to take into account psychological factors. Patients with unstable psychological indicators (nervous patients with increased lability of the nervous system) are sensitive to the initial placebo effect of most drugs, but long-term treatment in them is ineffective; Such patients are indicated for specific psychotropic therapy. Patients with unstable psychological indicators have a less favorable prognosis: the disease gradually leads them to disability.

15. What are the treatments for chest pain of esophageal origin not associated with gastroesophageal reflux?

Treatment of diseases not associated with esophageal achalasia is aimed at eliminating disturbances in the motor activity of the esophagus or visceral hypersensitivity. In this case, it is also possible to prescribe psychotropic drugs. If drug therapy is ineffective in some patients, it may be advisable to use more invasive treatment methods. Calcium antagonists, nitrates, and anticholinergics are first-line drugs for the treatment of esophageal motility disorders (for example, to eliminate the spastic component of the disease). If pain occurs rarely, sublingual use of short-acting nitrates or calcium antagonists (if necessary) is indicated. In patients with frequent painful attacks, continuous therapy with long-acting drugs is justified. Although the listed drugs can significantly change the value of intraesophageal pressure, their effectiveness in relation to the clinical manifestations of the disease is often insufficient. Benzodiazepines promote relaxation of skeletal muscles and also affect sensory innervation. However, their effectiveness for disorders of motor activity of the esophagus is low. As for other drugs used to alter the sensory innervation of the esophageal mucosa and its chemoreceptors, including anxiolytics and antidepressants, imipramine has recently been shown to be highly effective. This drug is used in low doses because its significant clinical effect is not thought to be due to its antidepressant properties. Several studies have examined the effectiveness of various psychotherapy and behavioral intervention techniques; however, they are currently not available to most physicians. In some cases, therapy with sedatives is successful; It is especially indicated for patients with a pronounced psychological component of the disease. Explaining to the patient the mechanisms of pain often produces positive results. After psychotherapy sessions, the frequency of both painful attacks and visits to the doctor decreases. The effectiveness of methods such as empirical bougienage and pneumatic dilatation (more targeted at the lower esophageal sphincter) of the esophagus is limited and is used only in some patients. Myotomy is effective for diffuse spasm of the esophagus or “nutcracker” esophagus. However, complications may develop with surgical interventions, and therefore they should be performed only in patients with severe disease. (For treatment of esophageal achalasia, see Chapter 5.)

16. Can pathological belching and aerophagia cause chest pain?

Distension of the esophageal wall, which occurs when gastric contents reflux, food retention, or air leakage, can cause chest pain. It has been proven that sometimes distension of the esophagus by gas occurred secondary to pathological belching. Normally, the upper esophageal sphincter relaxes in response to air distension. Violation of this response leads to pain.

17. What is the prognosis for patients with chest pain of unknown origin?

Patients with unexplained chest pain have a poor functional prognosis. They require consultations with a general practitioner or examinations in the emergency department on average twice a year. They have to be hospitalized on average once a year. If coronary heart disease is not detected, a more favorable diagnosis of esophageal lesions significantly improves the prognosis and reduces the frequency of hospitalization and examination of such patients. Despite the increasing incidence, the mortality rate of patients with unexplained chest pain does not differ from that in the general population (less than 1%).

Which doctor should I contact for treatment?

To find out why chest pain appears when swallowing while eating, you need to consult a gastroenterologist. However, the cause may not always be gastroenterological abnormalities. If after diagnosis the doctor does not find a reason for the symptom, he will refer the patient to other specialists. Often the symptom develops against the background of viruses and infections that are not associated with the gastrointestinal tract.

Painful sensations when swallowing, which appear frequently or persist for a long time, should be a cause for concern for the patient. If you feel discomfort, you should consult a doctor and undergo a full diagnosis. In 70-80% of cases, the cause is pathologies of the esophagus, which are life-threatening and require treatment. The remaining percentage is due to infections of the pharynx and the body as a whole, viruses, tumors and neoplasms that affect the condition and motility of the esophagus.

Pain when swallowing, as well as pain after eating, indicate a disease of the esophagus. Some symptoms may indicate intercostal neuralgia. Depending on the sensations and symptoms, the doctor examines the patient and makes a diagnosis. If the pain radiates to the chest and does not go lower, then there is a possibility of diagnosing a disease - cardiospasm of the esophagus. In any case, it is necessary to perform an ultrasound and endoscopy of all abdominal organs.

The doctor should also know what you take from food. There is a value in consuming fatty foods, eating deli meats and purchased vegetable salads. It is these three categories of foods that have a strong impact on the gastrointestinal tract. We cannot exclude the possibility of contracting an infection that proceeds quietly; cells such as salmonella live quite a long time in the body. When the stomach is damaged, they cause an acute reaction in the body.

Before eating food, purchased or prepared, you must wash your hands with soap. Each family member should have their own personal towel. Separately - a towel for hands and face.

When performing gastroscopy, it is important to highlight some points:

• Is there mucous on the walls of the stomach?
• Are there “stains” on the walls?
• What color is the general layer of the stomach?
• Is there any discharge from the “spots”.
• Are there black spots on the walls?
• Is there pain during gastroscopy inside the stomach?
• Do you suspect the presence of foreign bodies?

If we talk about foreign bodies, then it is important to mean something other than a direct meaning. Foreign bodies in the stomach are spots that cause cancer cells to multiply. As a result, they affect the walls of the esophagus, stomach and intestines. Hence - colic, frustration and spasms.

Associated symptoms

Damage to the esophagus interferes with the normal functioning of the digestive system. When pain does not go away for a long time, it affects your overall well-being. The long course of the disease begins to produce a characteristic clinical complex.

Symptoms of esophageal diseases:

1. Dysphagia or difficulty swallowing - the feeling of a lump in the middle of the sternum is accompanied by a problem with swallowing food. This can be caused by fear of pain, decreased salivation and severe mucosal damage.
2. Belching - appears immediately after eating or several hours later. It can be triggered by bending forward or physical activity.
3. Discomfort —disturbs during the passage of food through the esophagus. The flash of pain may last for several seconds, then gives way to discomfort.
4. Heartburn is a concern at any time, often appears after eating, and is accompanied by a feeling of a lump in the throat.

These symptoms may appear temporarily, then they can be removed with folk remedies or tolerated. When there is a suspicion of a disease, it is important to consult a doctor and find out the cause. The severity of pain in the esophagus depends on the cause and symptoms of the underlying disease. These can be injuries, infectious, tumor and inflammatory processes.

Chest pain caused by stomach problems

Your doctor may suspect stomach disease if you have symptoms of chest pain if:

• There are no changes in the electrocardiogram when a painful attack occurs.
• Low levels of cardiac-specific enzymes during ECG.
• Spasm of the esophagus when consuming certain medications.
• There is a fact confirming the presence of GI reflux.
• There is a consequence of gastrointestinal reflux in genesis of a decrease in the amount of gastric juice.

When the stomach is diseased, an organ closely connected to the esophagus, which is located near the chest, begins to produce enzymes to fight the disease. As soon as production has occurred, the secretion of the esophagus begins work to destroy the disease cells. The nearby sternum may be partially “affected” by the produced cells.

Scientifically speaking, spasmodic syndrome affects the entire area of ​​infection in which foreign cells infected with viruses, diseases, and parasites have appeared. Often women confuse chest pain with heart or larynx diseases. Diseases that radiate to other parts of the body can be distinguished by classifying them in relation to the spasms caused. Thus, based on the pain sensations in one organ, but based on the different nature of the manifestation, one or another diagnosis can be established.

Additional possible symptoms

Chest and throat pain is a symptom that appears alone quite rarely. Typically, the patient also complains of additional signs that can help the doctor in the differential diagnosis of the disease.

If the cause of the pain is problems in the respiratory system, the doctor will pay attention to whether the patient has a cough, whether he has shortness of breath not during physical activity, but at rest, and whether he experiences a feeling of lack of oxygen.

In addition to chest and throat pain, digestive pathologies are often accompanied by such unpleasant symptoms as belching, a feeling of nausea or vomiting, loss of appetite or, on the contrary, a constant desire to eat food.

Neurological diseases are often the most difficult to diagnose. This is due to the fact that pathologies are characterized by a variety of symptoms. The patient may complain of pain and digestive problems, the root of which lies in the pinched spinal nerve.

If a symptom such as chest and throat pain appears, many patients wonder how to treat themselves? It’s worth saying right away that since a symptom can be a consequence of many diseases, self-medication is highly discouraged for patients. It is necessary to consult a doctor so that he can select the appropriate therapy.

For lung diseases, the doctor will select, depending on the cause, medications that will alleviate the patient’s condition. These may be antiviral or antimicrobial drugs if the disease is caused by a viral or microbial agent.

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For gastrointestinal pathologies, depending on the cause, the doctor may prescribe, for example, antispasmodics or medications that reduce the acidity of gastric juice. For neuralgia, the patient will be given non-steroidal anti-inflammatory drugs, and novocaine blockades may be recommended. For hernias, experts will recommend surgical treatment.

How to treat a sore throat

Pain when swallowing - what kind of disease is it?

Severe and acute pain when swallowing food in the chest area can occur with a serious illness - esophagitis. This is an inflammation of the esophagus and stomach, which gradually develops into gastritis. As a rule, the pain radiates to the upper left and lower right parts of the chest. This type of pain when swallowing accompanies follicular tonsillitis. The patient's temperature may rise sharply or drop sharply after an attack.

Sometimes, with food poisoning, some areas of the larynx can be affected, which can also become sore after eating. Pain syndromes can be reflected in the intercostal space, which is often confused with neuralgia. A few days after the disease, the patient develops microbial activity. If this is not treated promptly, a person may develop a viral sore throat. In this case, enlarged lymph nodes are observed, and the pain intensifies when eating. A clot of spasm is concentrated in the chest area.

When the middle of the chest is affected, it is important to determine whether coronary heart disease can develop and whether there are hidden prerequisites for this. Since pain when swallowing cannot be concentrated in one place, it must be constantly diagnosed. As soon as it acquires the character of a “moving mechanism” and appears in different parts of the chest after eating, after taking pills, etc., there is a possibility of diagnosing heart disease.

It’s just that food can’t cause your throat and chest to hurt. To find out for sure whether something in the sternum hurts at all, whether there is any discomfort, just take a sip of water, not food.

If there is no painful sensation, then it is important to determine after which foods the spasm in the chest begins.

Possible diseases

Esophagitis is an inflammation of the lining of the esophageal tube.
The disease is the most common among all organ lesions. Inflammation can damage the deep layers of the esophagus. Its causes include injuries, burns, infections, and allergies. The disease can occur in both acute and chronic forms. It manifests itself as a sensation of a lump in the esophagus, a stake in the sternum, or distension. The patient complains of heaviness, lack of air, as if something is preventing him from swallowing and breathing. Reflux is a disorder associated with esophagitis. It is manifested by the release of stomach contents into the esophagus. This causes the acidic component to irritate its walls, leading to inflammation. The severity of symptoms will depend on the duration of the pathological process, the frequency of reflux, and the ability of the organ walls to resist an acidic environment. Without treatment, this disorder will cost the normal ability to swallow food with other severe complications.

Malignant tumor - a neoplasm on the wall of the esophagus will lead to various symptoms, including pain. Cancer is accompanied by spasms; the neoplasm blocks the lumen of the organ, which interferes with the passage of food. This will be accompanied by dull pain behind the sternum and dysphagia. When the esophagus hurts due to cancer, symptoms from other organs will not appear immediately. The long, latent course of oncology is life-threatening, so it is important to be examined by a doctor at the first warning signs.

A hiatal hernia is a condition in which part of the stomach and abdominal esophagus passes through a weakened hole in the diaphragm into the chest. The pathology is characterized by an asymptomatic course. A hernia produces temporary and vague symptoms. The patient may feel discomfort behind the sternum, and it is painful for him to bend forward after eating. Main manifestations: dyspepsia after eating in the form of heartburn, belching, hiccups, lump in the chest.

You can check for the presence of a hernia using an x-ray or other imaging methods, because an esophageal hernia does not appear externally. The diaphragm will put pressure on the organs, disrupting their function, and therefore other digestive disorders may appear.

Taking hormonal medications

It is worth immediately noting that not all hormonal drugs can cause complications in the larynx, esophagus, etc. But such cases should not be ruled out, since the set of hormones contained in 1 tablet can provoke an attack in a woman and a man. The dose for each person is selected individually.

You can often hear that women complain of pain when swallowing pills, mostly hormonal ones. Why is this happening? Is it possible that the dosage and “package” of hormones can cause a burning sensation and disruption of the digestive organs, giving off a syndrome in the chest area? No, that's not true. Even a strong concentration of substances cannot cause such sensations, because when swallowing tablets the organs are protected. All pills are in shells, so there is no direct contact.

Only gastric juice and enzymes can break them down.

But let’s return to the topic of taking drugs after eating, when there is already food in the stomach. Often, spasmodic syndromes can be caused when taking median. What side effects are observed after taking the pills:

• Bloody issues.
• Hair loss.
• The appearance of acne and rashes.
• Nausea and vomiting.
• Pain in the stomach and chest.

Also, do not forget that while taking this drug you should not use antibiotics, sleeping pills or medications for epilepsy. It is prohibited to use powders and tablets against viral infections and influenza. You should not drink St. John's wort or medications containing it. It is not recommended to take the drug before consuming food and alcohol. Alcohol-containing products are allowed in quantities that ultimately will not exceed the normal level of 0.16 ppm when exhaled, and 0.35 in the blood. They are also acceptable for driving vehicles.

Drug consumption rule

Any drug must be taken with plenty of water. When swallowing hormonal drugs or antibiotics before meals, you need to drink up to 200 ml of boiled water. It is not recommended to consume food within 30 minutes of taking the tablets. If you decide to change the analogue of the drug, then only an analogue of the same brand is acceptable. This includes Yarina, a hormonal drug that has the same effect.

Many gynecologists do not recommend stopping the drug for any reason for less than a month. If a woman experiences a strong burning sensation when swallowing, it is necessary to take a break for at least 2 months. Instead of this brand of birth control, you should use condoms. For 2 months, try to avoid taking any hormonal medication.

When resuming the course, you must consult a doctor. If you start taking it ahead of schedule, you may experience pain when swallowing the drug. Since at the end of the break a portion of new hormones enters the body, cramps and muscle spasms are possible. If a woman has chest pain and discharge continues, she should visit an endocrinologist.