Nutcracker esophagus differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
Nutcracker esophagus must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, esophageal adenocarcinoma and esophageal stricture. | |||
{| class="wikitable" | |||
! | |||
!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]] | |||
|- | |||
|[[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]] | |||
|- | |||
|[[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 12:31, 3 November 2017
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Nutcracker esophagus Microchapters |
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Overview
Differential Diagnosis
Nutcracker esophagus must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, esophageal adenocarcinoma and esophageal stricture.
| 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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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.