Esophageal Diseases
Arthi Kumaravel
Prashanthi Thota
The authors and editors gratefully acknowledge the contributions of the previous author, Tyler Stevens M.D. and Joel Richter M.D., on the development of this chapter.
KEY POINTS:
In most patients with classic symptoms of heartburn or regurgitation, the history alone is sufficient to diagnose gastroesophageal reflux disease (GERD) to permit a trial of therapy without diagnostic tests.
Diagnostic procedures
Barium esophagram: Single-most important test for the diagnosis of structural and motor abnormalities of the esophagus
Upper endoscopy with biopsy and brush cytology is the best method for identifying mucosal abnormalities
High-resolution esophageal manometry: Definitive test for diagnosis esophageal motility disorders
Ambulatory esophageal pH monitoring: For the diagnosis of gastroesophageal reflux
A pH evaluation is the single-best test for diagnosing GERD, with a sensitivity of 85% and a specificity > 95%.
GERD is classified into esophageal and extraesophageal syndromes
Extraesophageal symptoms are cough, laryngitis, asthma, and dental erosions. These symptoms are usually multifactorial with GERD being one of the contributing factors. In the absence of heartburn or regurgitation, unexplained cough, asthma, or laryngitis are unlikely to be related to GERD.
Early endoscopy is indicated in GERD patients with “alarm symptoms” such as dysphagia, vomiting, weight loss, anemia, or epigastric mass.
Protein pump inhibitors (PPIs) are the mainstay of therapy for GERD
Potential risks of long-term use of PPI therapy include increased risk of osteoporosis, clostridium difficile colitis, aspiration pneumonia, and Vitamin B12 deficiency.Related posts:
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