Esophageal stricture differential diagnosis: Difference between revisions
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!Manifestations | !Manifestations | ||
!Diagnostic tools | !Diagnostic tools | ||
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|Achalasia | |Achalasia | ||
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* Retrosternal burning chest pain. | * Retrosternal burning chest pain. | ||
* Cough and hoarseness of voice. | * Cough and hoarseness of voice. | ||
* May present with complications such as strictures and dysphagia. | * May present with complications such as strictures and dysphagia.<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> | ||
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* Upper GI endoscopy shows the complications such as esophagitis and barret esophagus. | * Upper GI endoscopy shows the complications such as esophagitis and barret esophagus. | ||
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*[[Dysphagia]] | *[[Dysphagia]] | ||
*[[Odynophagia]]- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty | *[[Odynophagia]]- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty<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> | ||
*[[Weight loss]] | *[[Weight loss]] | ||
*[[Pain and nociception|Pain]], often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character | *[[Pain and nociception|Pain]], often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character | ||
*[[Nausea]] and [[vomiting]] | *[[Nausea]] and [[vomiting]]<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> | ||
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* Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal | * Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal | ||
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|[[Esophageal spasm|Corckscrew esophagus]] | |[[Esophageal spasm|Corckscrew esophagus]] | ||
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*Retrosternal chest pain that presents with or without food intake. | *Retrosternal chest pain that presents with or without food intake.<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> | ||
*The condition is not progressive and not causing complications. | *The condition is not progressive and not causing complications.<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> | ||
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* Barium swallow shows the characteristic corckscrew appearance of the esophagus. | * Barium swallow shows the characteristic corckscrew appearance of the esophagus. | ||
[[Image:Nutcracker-esophagus-004.jpg|center|300px|thumb|Corckscrew esophagus - Case courtesy of Radswiki, Radiopaedia.org, rID: 11680]] | [[Image:Nutcracker-esophagus-004.jpg|center|300px|thumb|Corckscrew esophagus - Case courtesy of Radswiki, Radiopaedia.org, rID: 11680]] | ||
|- | |- | ||
| | |[[Esophageal stricture]] | ||
| | | | ||
*Patient may present with the symptoms of the underlying GERD. | |||
| | *Dysphagia and odynophagia.<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> | ||
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* Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention.<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> | |||
[[Image:Peptic stricture.png|center|300px|thumb|Peptic stricture - By Samir धर्म - From en.wikipedia.org, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1931423]] | |||
|- | |- | ||
| | |[[Plummer-Vinson syndrome]] | ||
|Common symptoms of Plummer-Vinson syndrome include:<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> | |||
*Difficulty swallowing (more for solids) | |||
| | *[[Weakness]] | ||
*[[Pain]] | |||
| | *Burning sensation in mouth | ||
| | *Dry tongue | ||
| | *Painful cracks in the angles of a dry mouth | ||
* | *Pale color of the skin | ||
===Less cmmon symptoms=== | |||
*Cold intolerance | |||
*Reduced resistance to infection | |||
*Altered behavior | |||
*Craving for for unusual items (such as ice or cold vegetables) | |||
* | |Lab tests are consistent with the diagnosis of iron deficiency anemia. | ||
Findings on an [[x-ray]] ([[barium]] [[esophagogram]]) suggestive of [[esophageal web]]/[[strictures]] associated with Plummer-Vinson syndrome appear as either: | |||
* Thin projections on the anterior [[esophageal]] wall. | |||
* Multiple upper ([[cervical]]) [[Esophageal stricture|esophageal constrictions]] consistent with [[esophageal webs]]. | |||
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[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Plummer-Vinson syndrome (Source: Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/14029">rID: 14029</a>)]] | |||
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Revision as of 14:03, 6 November 2017
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Esophageal stricture Microchapters |
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Esophageal stricture differential diagnosis On the Web |
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American Roentgen Ray Society Images of Esophageal stricture differential diagnosis |
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Risk calculators and risk factors for Esophageal stricture differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Differentiating Esophageal stricture from other Diseases
- Esophageal stricture must be differentiated from other diseases that cause dysphagia such as achalasia ,collagen vascular disease and schatzki ring.
- [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
- As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
Preferred Table
| Diseases | History and Symptoms | Physical Examination | Laboratory Findings | Other Findings | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dysphagia | |||||||||||||||
| Solids | Liquids | Intermittent | Progressive | Finding 3 | Finding
4 |
Physical Finding 1 | Physical Finding 2 | Physical Finding 3 | Physical Finding 4 | Lab Test 1 | Lab Test 2 | Lab Test 3 | Lab Test 4 | ||
| Esophageal stricture | + | + | + | + | |||||||||||
| Achalasia | +† | +† | - | ||||||||||||
| Collagen vascular disease | +† | +† | |||||||||||||
| Schatzki ring | + | ||||||||||||||
| Esophagitis | |||||||||||||||
†:Simultaneously to solids and liquids
Esophageal stricture must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, and esophageal adenocarcinoma.
| Manifestations | Diagnostic tools | |
|---|---|---|
| Achalasia |
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| GERD |
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| Esophageal carcinoma |
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| Corckscrew esophagus |
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| Esophageal stricture |
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| Plummer-Vinson syndrome | Common symptoms of Plummer-Vinson syndrome include:[9][10][11]
Less cmmon symptoms
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Lab tests are consistent with the diagnosis of iron deficiency anemia.
Findings on an x-ray (barium esophagogram) suggestive of esophageal web/strictures associated with Plummer-Vinson syndrome appear as either:
 |
References
- ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
- ↑ 2.0 2.1 2.2 Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
- ↑ 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.
- ↑ 4.0 4.1 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.
- ↑ Matsuura H (2017). "Diffuse Esophageal Spasm: Corkscrew Esophagus". Am. J. Med. doi:10.1016/j.amjmed.2017.08.041. PMID 28943381.
- ↑ Lassen JF, Jensen TM (1992). "[Corkscrew esophagus]". Ugeskr. Laeg. (in Danish). 154 (5): 277–80. PMID 1736462.
- ↑ 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.
- ↑ Shami VM (2014). "Endoscopic management of esophageal strictures". Gastroenterol Hepatol (N Y). 10 (6): 389–91. PMC 4080876. PMID 25013392.
- ↑ 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.
- ↑ Chisholm M (1974). "The association between webs, iron and post-cricoid carcinoma". Postgrad Med J. 50 (582): 215–9. PMC 2495558. PMID 4449772.
- ↑ 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.