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 oesophageal manometry
Investigations to consider
- chest x-ray
- radionucleotide oesophageal emptying studies
- timed barium oesophagogram
- CT chest
- impedance planimetry
Treatment algorithm
patients awaiting definitive treatment
good surgical candidate
poor surgical candidate
Contributors
Authors
Jamal Omar Hayat, MBBS, BSc, MRCP, MD (Res)
Consultant Gastroenterologist and Honorary Senior Lecturer
Department of Gastroenterology
St George's University Hospitals NHS Trust
London
UK
Disclosures
JOH is on the advisory board for Falk.
Jin-Yong Kang, MD, PhD, FRCP, FRCPEd, FRACP
Retired Consultant Gastroenterologist
London
UK
Disclosures
JYK declares that he holds shares in AstraZeneca.
Kalliopi Alexandropoulou, MD, FRCP
Consultant Gastroenterologist
Royal Surrey County Hospital
Guildford
Surrey
UK
Disclosures
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
- Oesophageal carcinoma
- Reflux oesophagitis
- Connective tissue disorders (e.g., systemic sclerosis)
More DifferentialsGuidelines
- Adverse events associated with EGD and EGD-related techniques
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
More Guidelines
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