13 - Symptoms of Esophageal Disease

Abstract

Common symptoms of esophageal disease include dysphagia, odynophagia, globus sensation, hiccups, chest pain, heartburn, regurgitation, and a number of extraesophageal complaints that have been attributed to gastroesophageal reflux. A carefully taken history can clarify many of these symptoms and is followed by selected testing, therapeutic trials, or both. Dysphagia is either proximal or distal and can be to solids only or to liquids and solids. Barium testing, manometry, and endoscopy are appropriate tests in a patient with dysphagia. Odynophagia usually indicates mucosal disease and should lead to endoscopy in most situations. The evaluation of globus sensation and hiccups usually does not yield a specific disorder, and the management is thus challenging. Chest pain can originate from the esophagus and frequently responds to gastric acid suppression. If reflux is not present, the evaluation and treatment of chest pain becomes challenging. Typical (heartburn and regurgitation) and extraesophageal symptoms potentially caused by GERD may respond to a diagnostic and therapeutic trial of acid suppression. Ambulatory pH testing is the best method to confirm reflux in these patients. Many of these esophageal symptoms may also occur in a patient with no objective evidence of pathology and are then considered and treated as functional disorders.