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| {| class="wikitable"
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| ! style="background: #4479BA; color: #FFFFFF; " align="center" |Disease
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| ! style="background: #4479BA; color: #FFFFFF; " align="center" |Signs & Symptoms
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| ! style="background: #4479BA; color: #FFFFFF; " align="center" |Findings on barium esophagogram
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| ! style="background: #4479BA; color: #FFFFFF; " align="center" |Findings on endoscopy
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| ! style="background: #4479BA; color: #FFFFFF; " align="center" |Other findings
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| |-
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| |Reflux esophagitis
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| * Dysphagia (from peptic stricture)
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|
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| * Heartburn
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|
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| * Hoarseness
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| * Poor clearance
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|
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| * Free reflux of barium
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| * Peptic stricture (advanced cases)
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| * Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux
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|
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| * A hiatus hernia may be present below the stricture
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|
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| * Manometry shows decreased tone of lower esophageal sphincter
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| |-
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| |Esophageal carcinoma
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| |
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| * Dysphagia (initially for solids, liquids develops with advanced disease.)
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|
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| * Weight loss
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|
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| * Lymphadenopathy
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|
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| * Cachexia
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| * Irregular stricture
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| * Pre-stricture dilatation
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| |
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| * Endoscopy with biopsy is the most accurate test for diagnosis and tumor histology. It may be used to depict:
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| ** Esophageal obstruction
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| ** Staging of disease
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| |
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| * CT scan and PET scan of the chest and abdomen is an optional test for staging of the disease
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| |-
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| |Systemic sclerosis
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| * Dysphagia
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|
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| * Muscle and joint pain
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|
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| * Raynaud's phenomenon
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|
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| * Skin changes (rash, skin thickening)
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| * Dysmotility
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|
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| * Patulous esophagus
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| * Mucosal damage
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|
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| * Peptic stricture (advanced cases)
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| |Positive serology for
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| * Antinuclear antibodies
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|
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| * Rheumatoid factor
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|
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| * Creatine kinase
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|
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| * ESR
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| |-
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| |Esophageal spasm
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| * Chest pain (more prominent)
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|
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| * Dysphagia (intermittent)
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| |
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| * Nonperistaltic and nonpropulsive contractions
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| * Corkscrew or rosary bead esophagus
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|
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| * Inconclusive
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| |
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| * Manometry shows high-amplitude esophageal contractions
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| * CT scan may show show hypertrophy of esophageal muscle wall
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| |-
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| |Pseudoachalasia
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| |
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| * Dysphagia
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|
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| * Weight loss
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|
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| * Lymphadenopathy
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|
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| * Appetite changes
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|
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| * Cachexia
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|
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| * Older patients
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|
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| * Underlying malignancy that mimics idiopathic achalasia.
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|
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| * Patients tend to be older, duration of symptoms shorter, and weight loss greater and more rapid.
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| |
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| * More marked mucosal irregularity
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|
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| * Temporary patency of LES
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| |
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| * Endoscopy with biopsy is the most accurate test for diagnosis and tumor histology. It may be used to depict:
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| ** Esophageal obstruction
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| ** Staging of disease
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|
| |
| |
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| * Gastroscopic biopsy of gastroesophageal junction and cardia may demonstrate malignancy.
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|
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| * Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia.
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| |-
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| |Chagas disease
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| * Dysphagia
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| * Toxic megacolon
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| * Myocarditis
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| * Blepharitis
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| |
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| * Esophageal dilatation
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| * Stasis of barium
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| * Dilated esophagus
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|
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| * Thickened LES (muscular ring)
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| |
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| * Giemsa stain will show ''Trypanosoma cruzi''.
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|
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| * PCR may be done to determine trypanosome subtype
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| |-
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| |Pharyngitis
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| * Dysphagia
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|
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| * Fever
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|
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| * Throat pain
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| * Normal
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| * Inconclusive
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| |
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| * Rapid antigen detection test positive for group A streptococccus
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| * Tonsillar hypertrophy may cause severe narrowing of the pharynx
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| * Physical exam may show:
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| ** Erythema, edema and/or exudates of the pharynx
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| ** Lymphadenopathy
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| |-
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| |Esophageal candidiasis
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| |
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| * Dysphagia
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|
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| * Immunocompromised
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|
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| * History of corticosteroid
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| |
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| * Shaggy" appearance (plaques)
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|
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| * Irregular contours in the lower third
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| |
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| * Ulceration
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|
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| * Plaques and pseudomembranes
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| * Tiny nodules, polypoid folds (advanced cases)
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| |
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| * Creamy white or yellowish plaques (thrush) in oropharynx
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| |-
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| |Stroke
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| |
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| * Progressive dysphagia
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|
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| * Dysarthria
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|
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| * Limb weakness
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|
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| * Fatigue
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| |
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| * Pooling of contrast in the pharynx
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| * Aspiration of barium contrast into the airway.
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| |
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| * Reduced opening of upper esophageal sphincter
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| * Reduced larynx elevation
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| |
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| * CT without contrast is the best initial test to differentiate between ischemic and hemorrhagic stroke
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| * MRI is more specific and sensitive than a CT scan but is more time consuming.
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| |}
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|
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| Plummer-Vinson syndrome must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, esophageal adenocarcinoma and esophageal stricture.
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| {| class="wikitable"
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| !
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| !Manifestations
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| !Diagnostic tools
| |
| |-
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| |Achalasia
| |
| |
| |
| * Dyspnea<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>
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|
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| *[[Dysphagia]] for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively<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>
| |
| *[[Regurgitation]] of undigested food occurs in 76-91% of patients<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>
| |
| *[[Cough]] mainly when lying down in 30%<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>
| |
| |
| |
| * Esophagogastroduodenoscopy findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]] (due to the prolonged stasis).
| |
| * Barium swallow shows the characteristic bird's beak appearance.
| |
| [[Image:Acha.jpg|center|300px|thumb|Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922]]
| |
| |-
| |
| |[[GERD]]
| |
| |
| |
| * Retrosternal burning chest pain.
| |
| * Cough and hoarseness of voice.
| |
| * 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>
| |
| |
| |
| * Upper GI endoscopy shows the complications such as esophagitis and barret esophagus.
| |
| * Esophageal manometry may show decreased tone of the lower esophageal sphincter.
| |
| * 24-hour esophageal pH monitoring may be done to confirm the diagnosis.
| |
| [[Image:Barretts esophagus.jpg|center|300px|thumb|Barret's esophagus - By Samir धर्म - taken from patient with permission to place in public domain, Copyrighted free use, https://commons.wikimedia.org/w/index.php?curid=1595945]]
| |
| |-
| |
| |[[Esophageal cancer|Esophageal carcinoma]]
| |
| |
| |
| *[[Dysphagia]]
| |
| *[[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]]
| |
| *[[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]]<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>
| |
| |
| |
| * Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
| |
| [[Image:Esophageal adenoca.jpg|center|300px|thumb|CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2587715]]
| |
| |-
| |
| |[[Esophageal spasm|Corckscrew esophagus]]
| |
| |
| |
| *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.<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>
| |
| |
| |
| * 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]]
| |
| |-
| |
| |[[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>
| |
| |
| |
| * 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 common 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]].
| |
|
| |
| [[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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|
| |
|
| ==References== | | ==References== |