Summary
Definition
History and exam
Key diagnostic factors
- dysphagia
Other diagnostic factors
- posturing to aid swallowing
- retrosternal pressure/pain
- regurgitation
- gradual weight loss
- heartburn
- slow eating
- coughing/choking while recumbent
- recurrent chest infections
- sensation of a lump in the throat (globus)
- hiccups
Risk factors
- herpes and measles viruses
- autoimmune disease
- HLA class II antigens
- consanguineous parents
- triple A (Allgrove) syndrome
Diagnostic investigations
1st investigations to order
- upper gastrointestinal endoscopy
- barium swallow
- high-resolution esophageal manometry
Investigations to consider
- chest x-ray
- radionucleotide esophageal emptying studies
- timed barium esophagogram
- CT chest
Treatment algorithm
patients awaiting definitive treatment
good surgical candidate
poor surgical candidate
Contributors
Authors
Jin-Yong Kang, MD, PhD, FRCP, FRCPEd, FRACP
Honorary Consultant Gastroenterologist
St George's Hospital
London
UK
Disclosures
JYK declares that he has no competing interests.
Kalliopi Alexandropoulou, MD, FRCP
Consultant Gastroenterologist
Royal Surrey County Hospital
Guildford
Surrey
UK
Disclosures
KA declares that he has no competing interests.
Acknowledgements
Dr Jin-Yong Kang would like to gratefully acknowledge Kalliopi Alexandropoulou, a previous contributor to this topic. KA declares that she has no competing interests.
Peer reviewers
Nigel Trudgill, MB ChB
Consultant Gastroenterologist
Sandwell General Hospital
West Bromwich
UK
Disclosures
NT declares that he has no competing interests.
John de Caestecker, BChir
Consultant in General Medicine
Leicester General Hospital
Leicester
UK
Disclosures
JdC declares that he has no competing interests.
David Hackam, MD, PhD
Assistant Professor of Surgery
Children's Hospital of Pittsburgh
Pittsburgh
PA
Disclosures
DH declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
Disclosures
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Differentials
- Esophageal carcinoma
- Reflux esophagitis
- Connective tissue disorders (e.g., systemic sclerosis)
More DifferentialsGuidelines
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
- International Society for Diseases of the Esophagus achalasia guidelines
More Guidelines
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