Esophagitis differential diagnosis: Difference between revisions

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{{Esophagitis}}
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==Overview==
Esophagitis must be differentiated from [[gastritis]], [[peptic ulcer]] disease, [[gastroesophageal reflux]] disease, [[acute coronary syndrome]], [[angina pectoris]], [[cholecystitis]], [[biliary colic]], [[pulmonary embolism]] and esophageal perforation, rupture and tears.
 
==Differential Diagnosis==
*Acute Coronary Syndrome
*Angina Pectoris
*Cholecystitis and Biliary Colic
*Esophageal Perforation, Rupture, and Tears
*Foreign Bodies, Gastrointestinal
*Gastritis and Peptic Ulcer Disease
*Gastroesophageal Reflux Disease
*Myocardial Infarction
*Peptic Ulcer Disease
*Pulmonary Embolism
*Candida esophagitis
 
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | |A01=Dysphagia}}
{{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | }}
{{familytree | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | | | B02 | |B01=Oropharyngeal dysphagia|B02=Esophageal dysphagia|}}
{{familytree | | | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
{{familytree | | | | | | | C01 | | | | | | | | | | | | | C02 | | | | | | | | | | | C03 | | | | | | | | | | C04 | |C01=Solids only|C02=Solids and Liquids|C03=Solids only|C04=Solids and Liquids|}}
{{familytree | | | | | | | |!| | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | |!| | | | | | | | | | | |!| | | |}}
{{familytree | | | | | | | D01 | | | | | | | | | | D02 | | | | D03 | | | | | | | | D04 | | | | | | | | | | D05 | | |D01=•Zenker's diverticulum<br>•Neoplasm<br>•Webs |D02=Neurogenic|D03=Myogenic|D04=Pain|D05=•Achalasia<br>•Scleroderma<br>•DES|}}
{{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | |!| | | | | | |,|-|-|^|-|-|-|.| | | | | | | |!| | | |}}
{{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | E01 | | | | | E02 | | | | | E03 | | | | | | E04 | |E01=•Myasthenia gravis<br>•Connective tissue disorder<br>•Myotonic dystrophy|E02=No|E03=Yes|E04=Heart burn|}}
{{familytree | | | | | | | F01 | | | | | | | | | | F02 | | | | | | | | | | | |!| | | | | | |!| | | | |,|-|-|^|-|-|.| |F01=Barium swallow|F02=Mental status|}}
{{familytree | | | | | | | |!| | | | | | | | |,|-|-|^|-|-|.| | | | | | |,|-|-|^|-|-|.| | | G01 | | | G02 | | | | G03 | |G01=•Pill esophagitis<br>•Caustic injury<br>•Chemotherapy|G02=Yes|G03=No|}}
{{familytree | | |,|-|-|-|-|+|-|-|-|-|.| | | H01 | | | | H02 | | | | | H03 | | | | H04 | | | | | | | |!| | | | | |!| | |H01=Impaired|H02=Normal|H03=Non progressive|H04=Progressive|}}
{{familytree | | I01 | | | I02 | | | I03 | | |!| | | | | |!| | | | | | |!| | | | | |!| | | | | | | | I04 | | | | I05 | I01=Sac|I02=Webs|I03=Mass|I04=Scleroderma|I05=•Achalasia<br>•DES|}}
{{familytree | | |!| | | | |!| | | | |!| | | J01 | | | | J02 | | | | | J03 | | | | J04 | | | | | | | | | | | | | |!| |J01=Stroke|J02=•ALS<br>•Parkinsonism| J03=•Rings<br>•Webs|J04=•Strictures<br>•Cancer|}}
{{familytree | | K01 | | | K02 | | | K03 | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | | | | | | | K04 |K01=Zenker's diverticulum|K02=Plummer-Vinson syndrome|K03=Carcinoma|K04=Chest pain and manometry|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | L01 | | | | L02 | | | | | | | | | | | | | |!| |L01=Barium swallow|L02=Weight loss|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | |!| | | | | | | | | | | | | | M01 | |M01=Increase LES pressure|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | N01 | | | | N02 | |!| | | | | | | | | | | |,|-|-|^|-|-|.| |N01=Rings|N02=Webs|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | O01 | | | | O02 | | |O01=Yes|O02=No|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | P01 | | | | P02 | | | | | | | |!| | | | | |!| | P01=Rapid|P02=Slow|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | Q01 | | | | Q02 | |Q01=Achalasia|Q02=DES|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | R01 | | | | R02 | | | | | | |R01=Cancer|R02=Strictures/GERD|}}
{{familytree/end}}
 
 
Eosinophilic esophagitis must be differentiated from other diseases that cause dysphagia such as [[reflux esophagitis]], [[esophageal carcinoma]], and [[systemic sclerosis]].<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref><ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume= | issue= | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref><ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref><ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref><ref name="pmid28943381">{{cite journal |vauthors=Matsuura H |title=Diffuse Esophageal Spasm: Corkscrew Esophagus |journal=Am. J. Med. |volume= |issue= |pages= |year=2017 |pmid=28943381 |doi=10.1016/j.amjmed.2017.08.041 |url=}}</ref><ref name="pmid1736462">{{cite journal |vauthors=Lassen JF, Jensen TM |title=[Corkscrew esophagus] |language=Danish |journal=Ugeskr. Laeg. |volume=154 |issue=5 |pages=277–80 |year=1992 |pmid=1736462 |doi= |url=}}</ref><ref name="pmid17227515">{{cite journal |vauthors=Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S |title=Esophageal stricture: incidence, treatment patterns, and recurrence rate |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2685–92 |year=2006 |pmid=17227515 |doi=10.1111/j.1572-0241.2006.00828.x |url=}}</ref><ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref><ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref>
 
{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs and Symptoms
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Barium esophagogram
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Endoscopy
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other imaging and laboratory findings
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold Standard
|-
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
| colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Dysphagia
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Heartburn
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other findings
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Mental status
|-
| align="center" style="background:#4479BA; color: #FFFFFF;" |Solids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Plummer-Vinson syndrome]]
|
* Gradual
| +
| -
|Non progressive
| +/-
| -
|
* [[Glossitis]]
 
* [[Koilonychia]]
 
|Normal
|
* Thin projections on the anterior [[esophageal]] wall
* Multiple upper [[Esophageal stricture|esophageal constrictions]]
|
* Direct visualization of [[esophageal webs]]
* Superior to [[esophagogram]]
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
 
|
Triad of
* [[Iron deficiency anemia]]
* [[Esophageal webs]]
* [[Glossitis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]]
|
* Gradual
 
* Sudden onset
| +
| -
|Progressive
| +/-
| +/-
|
* [[Odynophagia]]
* [[Cough]]
 
* [[Chest pain]]
|Normal
|
*Sacculations
*Fixed transverse folds
*[[Esophageal]] intramural pseudodiverticula   
|
* [[Mucosal]] edema
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/> ingestion
|
* [[Manometry]] may show dysmotility
* [[CT scan]] for staging [[malignant]] [[strictures]]
|
* [[Esophagogram|Barium esophagogram]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]]
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Non progressive
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Chest pain]]
 
|Normal
|
* Nonperistaltic and nonpropulsive contractions
* Corkscrew or rosary bead esophagus
|
* Inconclusive
|
*[[Manometry]] shows high-amplitude [[esophageal]] contractions
*[[CT scan]] may show [[hypertrophy]] of esophageal muscles
|
* [[Manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
|
* Gradual
| +
|<nowiki>+</nowiki>
|Non progressive
| +/-
| -
|
* [[Regurgitation]] of undigested food
* [[Chest pain]]
|Normal
|
* "Bird's beak" or "rat tail" appearance
* Dilated esophageal body
* Air fluid level (absent [[peristalsis]])
* Absence of an intragastric air bubble
|
* Dilated [[esophagus]]
* Residual food fragments
* Normal [[mucosa]]
|
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Incomplete relaxation of the [[Lower esophageal sphincter|LES]]
* Increased resting tone of [[Lower esophageal sphincter|LES]]
* Aperistalsis
|
* History of [[dysphagia]] with positive [[endoscopy]] and [[manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
|
* Gradual
| +
|<nowiki>+</nowiki>
|Progressive
| +/-
| +
|
* [[Muscle pain|Muscle]] and [[Arthralgia|joint pain]]
 
* [[Raynaud's phenomenon]]
 
* [[Skin changes]]
|Normal
|
* Dysmotility
 
* Patulous [[esophagus]]
|
* [[Mucosal]] damage
 
* [[Peptic]] stricture (advanced cases)
|Positive serology for
* [[Antinuclear antibodies]]
 
* [[Rheumatoid factor]]
 
* [[Creatine kinase]]
 
* [[ESR]]
|
* [[Skin biopsy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]]
|
* Gradual
| +
|<nowiki>-</nowiki>
|
| +/-
| -
|
* Food [[regurgitation]]
 
* [[Halitosis]]
 
* [[Coughing|Cough]]
 
* [[Hoarseness]]
|Normal
|
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
|
* Outpouching of posterior [[pharyngeal]] wall
 
* Exclude the presence of [[Squamous cell carcinoma|SCC]]
|
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
|
* Barium [[Esophagogram|esophagography]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
|
* Gradual
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
| +
|<nowiki>+/-</nowiki>
|
* [[Lymphadenopathy]]
 
* [[Cachexia]]
|Normal
|
* Irregular [[Strictures|stricture]]
* Pre-stricture [[dilatation]]
|
* [[Esophageal]] obstruction
* Staging of disease
|
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
|
* [[Biopsy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
([[Cerebral hemorrhage]])
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|
* [[Dysarthria]]
 
* Limb [[weakness]]
 
* [[Fatigue]]
|Impaired
|
* Pooling of [[Contrast medium|contrast]] in the [[pharynx]]
* [[Aspiration]] of [[barium]] [[Contrast medium|contrast]] into the [[airway]]
|
* Reduced opening of [[upper esophageal sphincter]]
* Reduced [[larynx]] elevation
|
* [[CT]] without [[contrast]] shows acute [[hemorrhage]] as a hyperattenuating [[clot]]
|
* [[CT]] without [[Contrast medium|contrast]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders
([[Myasthenia gravis]])
|
* Gradual
| +
| +
|Progressive
|<nowiki>+/-</nowiki>
|
|
* [[Ptosis]]
* [[Diplopia]]
* [[Fatigue]]
|Normal
|
* Stasis in [[pharynx]] and pooling in pharyngeal recesses
|
* [[Velopharyngeal insufficiency]]
* Delayed [[swallowing]] function
|
* CT may show anterior [[mediastinal]] mass ([[thymoma]])
* Positive tensilon test
|
* Anti–acetylcholine receptor antibody test
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
|
* Gradual
 
* Sudden onset
| +
| -
|Progressive
| +/-
| +
|
* [[Cough]]
 
* [[Hoarseness]]
|Normal
|
* Free acid reflux
* [[Esophagitis]] with scarring
* [[Strictures]]
* [[Barrett's oesophagus]]
|
* [[Erythema]], erosions and [[ulceration]]
* [[Barrett's esophagus]]
|
* Esophageal [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
|
* 24 hour [[esophageal]] pH monitoring
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]]
|
* Gradual
| +
| +/-
|Progressive
| -
| +/-
|
* Findings of the underlying cause such as [[iron deficiency anemia]] or [[bullous pemphigoid]]
|Normal
|
* Symmetrical narrowing of the [[esophagus]]
|
* Smooth membrane not encircling the whole [[Lumen (anatomy)|lumen]]
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
|
* Barium [[esophagogram]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Eosinophilic esophagitis]]
|Gradual
| +
|
|Progressive
| +/-
| +/-
|
* [[Chest pain]]
* Food impaction
* [[Cough]]
|Normal
|
* Multiple rings in the esophagus
|
* Concentric rings of the esophagus- Trachealization of the esophagus
|
* Increased serum IgE levels
|
* Esophageal biopsy
|}
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Needs content]]
 
[[Category:Gastroenterology]]

Latest revision as of 21:41, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ajay Gade MD[2]]

Overview

Esophagitis must be differentiated from gastritis, peptic ulcer disease, gastroesophageal reflux disease, acute coronary syndrome, angina pectoris, cholecystitis, biliary colic, pulmonary embolism and esophageal perforation, rupture and tears.

Differential Diagnosis

  • Acute Coronary Syndrome
  • Angina Pectoris
  • Cholecystitis and Biliary Colic
  • Esophageal Perforation, Rupture, and Tears
  • Foreign Bodies, Gastrointestinal
  • Gastritis and Peptic Ulcer Disease
  • Gastroesophageal Reflux Disease
  • Myocardial Infarction
  • Peptic Ulcer Disease
  • Pulmonary Embolism
  • Candida esophagitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oropharyngeal dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Esophageal dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solids only
 
 
 
 
 
 
 
 
 
 
 
 
Solids and Liquids
 
 
 
 
 
 
 
 
 
 
Solids only
 
 
 
 
 
 
 
 
 
Solids and Liquids
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Zenker's diverticulum
•Neoplasm
•Webs
 
 
 
 
 
 
 
 
 
Neurogenic
 
 
 
Myogenic
 
 
 
 
 
 
 
Pain
 
 
 
 
 
 
 
 
 
•Achalasia
•Scleroderma
•DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Myasthenia gravis
•Connective tissue disorder
•Myotonic dystrophy
 
 
 
 
No
 
 
 
 
Yes
 
 
 
 
 
Heart burn
 
 
 
 
 
 
 
Barium swallow
 
 
 
 
 
 
 
 
 
Mental status
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Pill esophagitis
•Caustic injury
•Chemotherapy
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Impaired
 
 
 
Normal
 
 
 
 
Non progressive
 
 
 
Progressive
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sac
 
 
Webs
 
 
Mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Scleroderma
 
 
 
•Achalasia
•DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stroke
 
 
 
•ALS
•Parkinsonism
 
 
 
 
•Rings
•Webs
 
 
 
•Strictures
•Cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Zenker's diverticulum
 
 
Plummer-Vinson syndrome
 
 
Carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chest pain and manometry
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Barium swallow
 
 
 
Weight loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increase LES pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rings
 
 
 
Webs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rapid
 
 
 
Slow
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Achalasia
 
 
 
DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cancer
 
 
 
Strictures/GERD
 
 
 
 
 
 


Eosinophilic esophagitis must be differentiated from other diseases that cause dysphagia such as reflux esophagitis, esophageal carcinoma, and systemic sclerosis.[1][2][3][4][5][6][7][8][9][10][11]

Disease Signs and Symptoms Barium esophagogram Endoscopy Other imaging and laboratory findings Gold Standard
Onset Dysphagia Weight loss Heartburn Other findings Mental status
Solids Liquids Type
Plummer-Vinson syndrome
  • Gradual
+ - Non progressive +/- - Normal

Triad of

Esophageal stricture
  • Gradual
  • Sudden onset
+ - Progressive +/- +/- Normal
  • Sacculations
  • Fixed transverse folds
  • Esophageal intramural pseudodiverticula   
Diffuse esophageal spasm
  • Sudden
+ + Non progressive + + Normal
  • Nonperistaltic and nonpropulsive contractions
  • Corkscrew or rosary bead esophagus
  • Inconclusive
Achalasia
  • Gradual
+ + Non progressive +/- - Normal
  • "Bird's beak" or "rat tail" appearance
  • Dilated esophageal body
  • Air fluid level (absent peristalsis)
  • Absence of an intragastric air bubble
  • Residual pressure of LES > 10 mmHg
  • Incomplete relaxation of the LES
  • Increased resting tone of LES
  • Aperistalsis
Systemic sclerosis
  • Gradual
+ + Progressive +/- + Normal
  • Dysmotility
  • Peptic stricture (advanced cases)
Positive serology for
Zenker's diverticulum
  • Gradual
+ - +/- - Normal
  • Exclude the presence of SCC
  • CT & MRI shows out-pouching over the posterior esophagus in the Killian's triangle
Esophageal carcinoma
  • Gradual
+ + Progressive + +/- Normal
  • CT and PET scan is an optional test for staging of the disease
Stroke

(Cerebral hemorrhage)

  • Sudden
+ + Progressive + +/- Impaired
Motor disorders

(Myasthenia gravis)

  • Gradual
+ + Progressive +/- Normal
  • Stasis in pharynx and pooling in pharyngeal recesses
  • Anti–acetylcholine receptor antibody test
GERD
  • Gradual
  • Sudden onset
+ - Progressive +/- + Normal
Esophageal web
  • Gradual
+ +/- Progressive - +/- Normal
  • Smooth membrane not encircling the whole lumen
Eosinophilic esophagitis Gradual + Progressive +/- +/- Normal
  • Multiple rings in the esophagus
  • Concentric rings of the esophagus- Trachealization of the esophagus
  • Increased serum IgE levels
  • Esophageal biopsy

References

  1. Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  2. Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
  3. Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
  4. Napier KJ, Scheerer M, Misra S (2014). "Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities". World J Gastrointest Oncol. 6 (5): 112–20. doi:10.4251/wjgo.v6.i5.112. PMC 4021327. PMID 24834141.
  5. Matsuura H (2017). "Diffuse Esophageal Spasm: Corkscrew Esophagus". Am. J. Med. doi:10.1016/j.amjmed.2017.08.041. PMID 28943381.
  6. Lassen JF, Jensen TM (1992). "[Corkscrew esophagus]". Ugeskr. Laeg. (in Danish). 154 (5): 277–80. PMID 1736462.
  7. Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S (2006). "Esophageal stricture: incidence, treatment patterns, and recurrence rate". Am. J. Gastroenterol. 101 (12): 2685–92. doi:10.1111/j.1572-0241.2006.00828.x. PMID 17227515.
  8. Shami VM (2014). "Endoscopic management of esophageal strictures". Gastroenterol Hepatol (N Y). 10 (6): 389–91. PMC 4080876. PMID 25013392.
  9. López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I (2002). "Sideropenic dysphagia in an adolescent". J. Pediatr. Gastroenterol. Nutr. 34 (1): 87–90. PMID 11753173.
  10. Chisholm M (1974). "The association between webs, iron and post-cricoid carcinoma". Postgrad Med J. 50 (582): 215–9. PMC 2495558. PMID 4449772.
  11. Larsson LG, Sandström A, Westling P (1975). "Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden". Cancer Res. 35 (11 Pt. 2): 3308–16. PMID 1192404.

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