Dysphagia, weight loss and heartburn: Difference between revisions

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{{CMG}}; {{AE}} {{Ajay}}
{{CMG}}; {{AE}} {{Ajay}}


''' To review the wikidoc topic on dyspagia [[Dysphagia|click here]]
''' To review the wikidoc topic on dyspagia [[Dysphagia|click here]]'''
==Differential Diagnosis of Dysphagia, Weight loss and Heartburn==
==Differential Diagnosis of Dysphagia, Weight loss and Heartburn==


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| align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
| 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]]  
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]]  
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|
|
* [[Manometry]]
* [[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]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
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|
|
* [[Skin biopsy]]
* [[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]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
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|
|
* [[CT]] without [[Contrast medium|contrast]]
* [[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]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
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|
|
* 24 hour [[esophageal]] pH monitoring
* 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]]
|}
|}

Revision as of 17:39, 7 December 2017


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

To review the wikidoc topic on dyspagia click here

Differential Diagnosis of Dysphagia, Weight loss and Heartburn

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
Esophageal stricture Gradual or sudden + - 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
Systemic sclerosis Gradual + + Progressive +/- + Normal
  • Dysmotility
  • Peptic stricture (advanced cases)
 Positive serology for
Esophageal carcinoma Gradual + + Progressive + +/- Normal
  • CT and PET scan is an optional test for staging of the disease
Stroke

(Cerebral hemorrhage)

Sudden + + Progressive + +/- Impaired
GERD Gradual or

sudden onset

+ - Progressive +/- + Normal
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