Gastroesophageal reflux disease differential diagnosis: Difference between revisions
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GERD must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as esophageal adenocarcinoma and esophageal stricture. | |||
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! | |||
!Manifestations | |||
!Diagnostic tools | |||
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|Achalasia | |||
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* 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> | |||
*[[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> | |||
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* 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]] | |||
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|[[GERD]] | |||
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* Retrosternal burning chest pain. | |||
* Cough and hoarseness of voice. | |||
* May present with complications such as strictures and dysphagia. | |||
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* 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]] | |||
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|[[Esophageal cancer|Esophageal carcinoma]] | |||
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*[[Dysphagia]] | |||
*[[Odynophagia]]- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty | |||
*[[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]] | |||
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* 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]] | |||
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|[[Esophageal spasm|Corckscrew esophagus]] | |||
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*Retrosternal chest pain that presents with or without food intake. | |||
*The condition is not progressive and not causing complications. | |||
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* 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]] | |||
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*Patient may present with the symptoms of the underlying GERD. | |||
*Dysphagia and odynophagia. | |||
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* Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention. | |||
[[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]] | |||
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==References== | ==References== |
Revision as of 12:29, 3 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Differentiating Gastroesophageal Reflux Disease from other Diseases
- Peptic ulcer disease
- Esophageal infections (HIV, CAV)
- Esophagitis
- Esophageal motor disorders
- Coronary artery disease
- Esophageal cancer
- Crohn's disease
- Candida esophagitis
Differential Diagnosis
Gastroesophageal reflux disease must be differentiated from:[1][2][3][4][5][6][7][8][9]
Disease | Cause | Symptoms | Diagnosis | Other findings | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Pain | Nausea
& Vomiting |
Heartburn | Belching or
Bloating |
Weight loss | Loss of
Appetite |
Stools | Endoscopy findings | |||||
Location | Aggravating Factors | Alleviating Factors | ||||||||||
Acute gastritis |
|
Food | Antacids | ? | ? | ? | - | ? | Black stools | - | ||
Chronic gastritis |
|
Food | Antacids | ? | ? | ? | ? | ? | - | H. pylori gastritis
Lymphocytic gastritis
|
- | |
Atrophic gastritis | Epigastric pain | - | - | ? | - | ? | ? | - | H. pylori
|
Autoimmune gastritis diagnosis include:
| ||
Crohn's disease | - | - | - | - | - | ? | ? |
|
|
|||
GERD |
|
|
|
?
(Suspect delayed gastric emptying) |
? | - | - | - | - |
|
Other symptoms:
Complications
| |
Peptic ulcer disease |
|
|
Duodenal ulcer
|
|
? | ? | - | - | - | Gastric ulcers
Duodenal ulcers
|
Other diagnostic tests | |
Gastrinoma |
|
- | - | ?
(suspect gastric outlet obstruction) |
? | - | - | - | Useful in collecting the tissue for biopsy |
Diagnostic tests
| ||
Gastric Adenocarcinoma |
|
- | - | ? | ? | ? | ? | ? |
|
Esophagogastroduodenoscopy
|
Other symptoms | |
Primary gastric lymphoma |
|
- | - | - | - | - | ? | - | - | Useful in collecting the tissue for biopsy | Other symptoms
|
GERD must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as esophageal adenocarcinoma and esophageal stricture.
Manifestations | Diagnostic tools | |
---|---|---|
Achalasia |
|
![]() |
GERD |
|
![]() |
Esophageal carcinoma |
|
![]() |
Corckscrew esophagus |
|
![]() |
Esophageal stricture |
|
![]() |
References
- ↑ Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). "Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy". Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.
- ↑ Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.
- ↑ Sartor RB (2006). "Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis". Nat Clin Pract Gastroenterol Hepatol. 3 (7): 390–407. doi:10.1038/ncpgasthep0528. PMID 16819502.
- ↑ Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.
- ↑ 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.
- ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
- ↑ Banasch M, Schmitz F (2007). "Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors". Wien Klin Wochenschr. 119 (19–20): 573–8. doi:10.1007/s00508-007-0884-2. PMID 17985090.
- ↑ Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM (2005). "Gastric adenocarcinoma: review and considerations for future directions". Ann Surg. 241 (1): 27–39. PMC 1356843. PMID 15621988.
- ↑ Ghimire P, Wu GY, Zhu L (2011). "Primary gastrointestinal lymphoma". World J Gastroenterol. 17 (6): 697–707. doi:10.3748/wjg.v17.i6.697. PMC 3042647. PMID 21390139.
- ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
- ↑ 11.0 11.1 11.2 Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.