Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- bowel sounds in chest
Other diagnostic factors
- heartburn
- regurgitation
- obesity
- chest pain
- dysphagia
- odynophagia
- haematemesis
- shortness of breath
- cough
- oropharyngitis
- wheezing
- non-bilious vomiting
- fever and chills
- confusion
Risk factors
- obesity
- increased age
- previous gastro-oesophageal procedure
- elevated intra-abdominal pressure
- male sex
- structural abnormalities of the oesophageal hiatus or the phreno-oesophageal ligaments
- incisional, umbilical, or inguinal hernia
- disorder of collagen metabolism
Diagnostic investigations
1st investigations to order
- chest x-ray
- contrast upper gastrointestinal series (barium oesophagram)
Investigations to consider
- oesophago-gastro-duodenoscopy
- CT scan or MRI scan
- high-resolution oesophageal manometry and pH monitoring
Treatment algorithm
upper gastrointestinal haemorrhage and/or obstruction and/or volvulus
irreversible organ ischaemia and/or necrosis
symptomatic gastro-oesophageal reflux disease (GORD)
type I refractory to medical therapy or patient prefers surgery
types II, III, and IV
Contributors
Authors
Constantine T. Frantzides, MD, PhD, FACS

Director
Chicago Institute of Minimally Invasive Surgery
St. Francis Hospital
Clinical Professor of Surgery
University of Illinois Chicago
Chicago
IL
Disclosures
CTF declares that he has no competing interests.
Amy J. Hargrove, MD, MPH
General Surgery Resident
University of Nebraska Medical Center
Omaha
NE
Disclosures
AJH declares that she has no competing interests.
Mark A. Carlson, MD, FACS
Director
Center for Advanced Surgical Technology
Professor
Department of Surgery
University of Nebraska Medical Center
Omaha
NE
Disclosures
MAC declares that he has no competing interests.
Acknowledgements
Dr Constantine T. Frantzides, Dr Amy Hargrove, and Dr Mark A. Carlson would like to gratefully acknowledge Dr Minh B. Luu, a previous contributor to this topic. MBL declares that he has no competing interests.
Peer reviewers
Frank A. Granderath, MD
Associate Professor
Department of General, Visceral and Transplant Surgery
University Hospital Tuebingen
Germany
Disclosures
FAG declares that he has no competing interests.
Differentials
- Angina pectoris
- Gastro-oesophageal reflux disease (GORD)
- Pneumonia
More DifferentialsGuidelines
- Informed consent for GI endoscopic procedures
- Adverse events associated with EGD and EGD-related techniques
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