When does the pain occur?

Irradiation is a cornerstone in the treatment of malignant tumors. It involves irradiating the affected area with harmful rays from the outside and directing the rays as best as possible towards the cancer. The DNA of the cells is to be damaged so that the cells perish and the cancer shrinks.

With cancer illnesses in the neck range likewise a radiation can be used. In particular carcinomas of the esophagus or the thyroid gland are possible. Especially parts of the mucous membrane of the esophagus are affected by radiation.

Although the mucous membrane can recover from this to a large extent, the long-term consequences of the damage can be serious. Inflammation of the oesophagus due to radiation is a common side effect. It occurs a few weeks after the first irradiation.

The typical symptoms are chest pain with difficulty swallowing and a foreign body sensation in the esophagus. If a patient feels pain in the area of the esophagus while drinking, this too can have various causes. In this context, the question arises as to whether the symptoms are caused by drinking hot or cold drinks or whether only drinking acidic liquids (for example: lemonade, cola or fruit juices) causes pain.

Possible causes for the development of pain in the area of the esophagus, which occurs during drinking or is intensified by the fluid intake, are lesions of the esophageal mucosa. In this case, burning pain occurs especially when drinking acidic drinks. Regular consumption of alcohol is a risk factor for a variety of diseases.

In addition to damage to the cardiovascular system and the liver, excessive consumption of alcohol can also cause long-term damage to the esophagus.Both smoking and excessive consumption of alcohol is the most important risk factor for the development of the so-called “squamous cell carcinoma of the esophagus” (esophageal cancer). Especially the simultaneous consumption of nicotine and alcohol increases the risk many times over. Furthermore, alcohol has been proven to increase the production of gastric acid.

This, in turn, can lead to persistent and/or frequently recurring reflux (heartburn; ascension of gastric acid into the esophagus). In both cases, the affected patients experience severe pain in the area of the esophagus which typically increases in intensity during and after the consumption of alcohol. This phenomenon is due to alcohol-induced irritation of the esophageal mucosa.

Pain in the area of the esophagus, which occurs mainly during eating, can be a leading symptom of various diseases. The actual cause, which in all relevant diseases leads to the occurrence of pain while eating (rather during the swallowing process), is movement disorders of the esophageal muscles or mechanical obstacles. The most common mechanical obstacle that leads to the development of pain in the esophagus, which occurs mainly during eating, is the so-called esophageal diverticulum.

This is a condition in which there are small bulges that block the esophagus. When eating, the still relatively firm chyme has to pass through these bulges and causes severe pain due to the narrowness. In addition, membranes, constrictions caused by scar tissue or foreign bodies can block the esophagus and thus cause pain, especially when eating.

Furthermore, inflammatory processes inside the esophagus or ulcers/tumors can cause pain while eating. Due to the close anatomical relationship to the esophagus, thyroid ulcers can also cause pain in the esophagus due to external pressure, especially when eating or drinking. Also reflux disease or heartburn can cause pain in the esophagus after eating.

If pain in the esophagus occurs during the swallowing process, acid-induced esophagitis is not to be assumed in the first instance. The exact time of the pain and any accompanying symptoms are important for diagnosis. If, in addition to the pain behind the breastbone, there is also a choking up of food or frequent swallowing, this is known as “dysphagia”.

This is the inability to swallow, which is often found when the oesophageal muscle is too tight or when there is constipation due to excessive amounts of food. A common problem, which need not be an indication of illness, is an acute stabbing pain after swallowing a large bite. This leads to a brief blockage of the oesophagus with severe pain and possibly to choking of the food.

If the oesophagus is permanently constricted, such a pain when swallowing occurs even with normal food intake. This can be caused by medication, infections, diverticula or malignant changes in the esophagus. The mobility and the swallowing process of the esophagus are strongly impaired.

A narrowing of the esophagus with subsequent pain when swallowing can also be a long-term consequence of reflux disease. The inflammation is so advanced that scarred changes in the wall of the esophagus cause the pain. The mucous membrane lining the esophagus is very sensitive to chemical stimuli compared to the stomach mucosa.

The permanent rise of gastric acid (for example, due to chronic reflux) can cause long-term damage to the mucous membrane of the esophagus for this reason. Even during vomiting there is direct contact between the mucous membrane of the oesophagus and stomach acid. This irritates the esophagus and can cause pain.

This leads to extensive damage to the oesophagus, especially after prolonged and pathological vomiting (e.g. due to eating and vomiting addiction). In most cases, the affected patients develop a persistent pain in the area of the esophagus which increases significantly in intensity after vomiting. A cough does not only occur with infections and inflammations of the airways.

In rare cases, coughing can be a side effect of reflux disease. Suspicious is a cough that persists for a long time and occurs only with burning pain behind the sternum without accompanying infectious disease. The cause for this cough is a simple nerve irritation.The affected nerves are located at the transition from the esophagus to the stomach and are irritated during acid reflux.

In addition to the inflammation of the mucous membrane of the lower esophagus, the nerves can trigger a coughing impulse via the brain. In addition to coughing, hoarseness, sore throat and increased mucus formation also occur. What sounds like a typical infection, however, is a symptom of the esophagus.

In the case of severe acid reflux of the esophagus, gastric juice and chyme can be bursting from the stomach. If the affected person is lying down, the gastric juice may enter the larynx and erroneously flow into the lungs. Severe coughing is the acute consequence.

This can cause inflammation of the lungs and respiratory tract via pathogens. Bronchitis via this route is not uncommon. Some diseases of the esophagus cause pain that radiates into the back.

Among the most common diseases that cause pain in the back are ruptures and perforations of the esophagus. Although the esophagus is a fairly stable muscle tube, changes in the wall structure or traumatic events can affect its stability. Tears and perforations of the esophagus, which can lead to pain in the area of the breastbone and radiate into the back, are generally rare.

A typical reason that can lead to a rupture of the esophagus is the sticking of a foreign body. In addition, therapeutic stomach probes that persist in the lumen of the esophagus for too long can lead to its rupture with pain in the area of the breastbone that radiates into the back. In these cases, one speaks of a so-called “perforation of the esophagus” (esophageal tear).

If a patient’s esophagus is pre-damaged, injury to the muscle tube can occur while an endoscopic examination is being performed (e.g. gastroscopy). In most cases, a tear or rupture of the esophagus can be recognized by very classic symptoms. In the case of a tear in the upper area, affected patients notice sudden pain in the neck or throat area.

In addition, there may be significant skin reactions and swelling (skin emphysema). This is particularly noticeable if the esophagus in the upper section has been damaged. The swelling is caused by air that comes out of the esophagus and spreads through the tissue.

Patients who have an esophageal tear in the lower section of the muscle tube classically complain of severe chest and back pain. If treatment is not initiated promptly, the esophageal rupture with pain in the back can lead to inflammatory processes in the chest area. In these cases one speaks of a so-called “mediastinitis” which is accompanied by high fever and pronounced shock symptoms (palpitations, trembling, sweating). The treatment of an esophageal rupture with pain in the back (i.e. a deep-seated rupture) should be carried out within 24 hours by means of reconstructive surgery.