Esophageal stricture differential diagnosis: Difference between revisions

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__NOTOC__
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{{Esophageal stricture}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Esophageal_stricture]]
{{CMG}}; {{AE}} {{MA}}
{{CMG}}; {{AE}} {{MA}}


==Overview==
==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].
Esophageal stricture must be differentiated from Plummer-Vinson syndrome, [[achalasia]], [[diffuse esophageal spasm]], [[systemic sclerosis]], [[zenker's diverticulum]], [[Esophageal cancer|esophageal carcinoma]], [[stroke]], motor disorders, [[GERD]][[Esophageal web|, esophageal web]].
 
OR
 
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Differentiating Esophageal stricture from other Diseases==
==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.
*Esophageal stricture must be differentiated from other diseases that cause [[dysphagia]] such as Plummer-Vinson syndrome, [[achalasia]] , [[diffuse esophageal spasm]], [[systemic sclerosis]], [[zenker's diverticulum]], [[Esophageal cancer|esophageal carcinoma]], [[stroke]]([[cerebral hemorrhage]]), motor disorders ([[myasthenia gravis|Myasthenia Gravis]]), [[GERD]][[Esophageal web|, esophageal web]].
*[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===




 
<br><br><small><small>
Esophageal stricture must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, and esophageal adenocarcinoma.
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Plummer-Vinson syndrome must be differentiated from other diseases that cause dysphagia such as [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[esophageal spasm]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]] and [[Chagas disease]].<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><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><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><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><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><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><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><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><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>


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===Preferred Table===
<small>
{| class="wikitable"
{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs and Symptoms
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Signs and Symptoms
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Barium esophagogram
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Barium esophagogram
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Endoscopy
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Endoscopy
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other imaging and laboratory findings
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Other imaging and laboratory findings
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold Standard
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold Standard
|-
|-
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Onset
| colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Dysphagia
| colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Dysphagia
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Heartburn
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Heartburn
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other findings
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other findings
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Mental status
| rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Mental status
|-
|-
| align="center" style="background:#4479BA; color: #FFFFFF;" |Solids
| style="background:#4479BA; color: #FFFFFF;" align="center" |Solids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids
| style="background:#4479BA; color: #FFFFFF;" align="center" |Liquids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
| style="background:#4479BA; color: #FFFFFF;" align="center" |Type
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Plummer-Vinson syndrome
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Plummer-Vinson syndrome]]
|Gradual
|
* Gradual
| +
| +
| -
| -
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|Normal
|Normal
|
|
* Thin projections on the anterior [[esophageal]] wall
* Thin projections on the anterior [[esophageal]] wall
* Multiple upper[[Esophageal stricture|esophageal constrictions]]
* Multiple upper [[Esophageal stricture|esophageal constrictions]]
|
[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Barium esophagogram (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>)]]
|  
* Direct visualization of [[esophageal webs]]
* Direct visualization of [[esophageal webs]]
* Superior to [[esophagogram]]
* Superior to [[esophagogram]]
<div style="width:350px">{{#ev:youtube|HFfsTgsB6Pg}}</div>
|
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]]  
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]]  
|Gradual or sudden
|
* Gradual
 
* Sudden onset
| +
| +
| -
| -
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*Fixed transverse folds
*Fixed transverse folds
*[[Esophageal]] intramural pseudodiverticula   
*[[Esophageal]] intramural pseudodiverticula   
[[Image:Benign-oesophageal-stricture.jpg|center|200px|thumb|Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 23008]]
|
|
* [[Mucosal]] edema
* [[Mucosal]] edema
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
 
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/> ingestion
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/>ingestion
<div style="width:350px">{{#ev:youtube|-vax5E-jMnQ}}</div>
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|
* [[Manometry]] may show dysmotility
* [[Manometry]] may show dysmotility
* [[CT scan]] for staging [[malignant]] [[strictures]]
* [[CT scan]] for staging [[malignant]] [[strictures]]
|
|
* No gold standard test
* [[Esophagogram|Barium esophagogram]]
* Diagnostic study based on history of [[dysphagia]], positive [[Esophagogram|barium esophagogram]]<nowiki/>and [[endoscopy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]]
|Sudden
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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* Nonperistaltic and nonpropulsive contractions
* Nonperistaltic and nonpropulsive contractions
* Corkscrew or rosary bead esophagus
* Corkscrew or rosary bead esophagus
[[Image:DES radio.png|center|200px|thumb|Barium swallow appearance of DES<br>Source:By Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]]
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|
* Inconclusive
* Inconclusive
<div style="width:350px">{{#ev:youtube|2ipA34iMA3c}}</div>
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*[[Manometry]] shows high-amplitude [[esophageal]] contractions
*[[Manometry]] shows high-amplitude [[esophageal]] contractions
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
|Gradual
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* Gradual
| +
| +
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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* Air fluid level (absent [[peristalsis]])
* Air fluid level (absent [[peristalsis]])
* Absence of an intragastric air bubble
* Absence of an intragastric air bubble
[[Image:Achalasia-2.jpg|center|200px|thumb|Case courtesy of Dr Mario Umana, Radiopaedia.org, rID: 38071]]
|
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* Dilated [[esophagus]]
* Dilated [[esophagus]]
* Residual food fragments  
* Residual food fragments  
* Normal [[mucosa]]  
* Normal [[mucosa]]  
<div style="width:350px">{{#ev:youtube|ydLcskQzEjM}}</div>
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* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
|Gradual
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* Gradual
| +
| +
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]]
|Gradual
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* Gradual
| +
| +
|<nowiki>-</nowiki>
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|
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* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
[[Image:Zenker-4.jpg|center|200px|thumb| Radiopaedia.org">{{cite web |url=https://radiopaedia.org/cases/zenker-diverticulum |title=Zenker diverticulum &#124; Radiology Case &#124; Radiopaedia.org |format= |work= |accessdate=}}<nowiki></ref></nowiki>]]
|
|
* Outpouching of posterior [[pharyngeal]] wall
* Outpouching of posterior [[pharyngeal]] wall


* Exclude the presence of [[Squamous cell carcinoma|SCC]] 
* Exclude the presence of [[Squamous cell carcinoma|SCC]]
<div style="width:350px">{{#ev:youtube|FdEruFsNdVA}}</div> 
|
|
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
|Gradual
|
* Gradual
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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* Irregular [[Strictures|stricture]]
* Irregular [[Strictures|stricture]]
* Pre-stricture [[dilatation]]
* Pre-stricture [[dilatation]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
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* [[Esophageal]] obstruction
* [[Esophageal]] obstruction
* Staging of disease
* Staging of disease
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
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* [[CT]] and [[PET scan]] is an optional test for staging of the disease
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
([[Cerebral hemorrhage]])
([[Cerebral hemorrhage]])
|Sudden
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders
([[Myasthenia gravis]])
([[Myasthenia gravis]])
|Gradual
|
* Gradual
| +
| +
| +
| +
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
|Gradual or
|
* Gradual


sudden onset
* Sudden onset
| +
| +
| -
| -
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]]
|Gradual
|
* Gradual
| +
| +
| +/-
| +/-
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* Barium [[esophagogram]]
* Barium [[esophagogram]]
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<small>


{| class="wikitable"
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*Pale color of the skin
*Pale color of the skin


===Less cmmon symptoms===
===Less common symptoms===
*Cold intolerance
*Cold intolerance
*Reduced resistance to infection
*Reduced resistance to infection
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
|}
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Differential diagnosis]]

Latest revision as of 21:40, 29 July 2020

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

Overview

Esophageal stricture must be differentiated from Plummer-Vinson syndrome, achalasia, diffuse esophageal spasm, systemic sclerosis, zenker's diverticulum, esophageal carcinoma, stroke, motor disorders, GERD, esophageal web.

Differentiating Esophageal stricture from other Diseases





 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oropharyngeal dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Esophageal dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solids only
 
 
 
 
 
 
 
 
 
 
 
 
Solids and Liquids
 
 
 
 
 
 
 
 
 
 
Solids only
 
 
 
 
 
 
 
 
 
Solids and Liquids
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Zenker's diverticulum
•Neoplasm
•Webs
 
 
 
 
 
 
 
 
 
Neurogenic
 
 
 
Myogenic
 
 
 
 
 
 
 
Pain
 
 
 
 
 
 
 
 
 
•Achalasia
•Scleroderma
•DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Myasthenia gravis
•Connective tissue disorder
•Myotonic dystrophy
 
 
 
 
No
 
 
 
 
Yes
 
 
 
 
 
Heart burn
 
 
 
 
 
 
 
Barium swallow
 
 
 
 
 
 
 
 
 
Mental status
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Pill esophagitis
•Caustic injury
•Chemotherapy
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Impaired
 
 
 
Normal
 
 
 
 
Non progressive
 
 
 
Progressive
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sac
 
 
Webs
 
 
Mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Scleroderma
 
 
 
•Achalasia
•DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stroke
 
 
 
•ALS
•Parkinsonism
 
 
 
 
•Rings
•Webs
 
 
 
•Strictures
•Cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Zenker's diverticulum
 
 
Plummer-Vinson syndrome
 
 
Carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chest pain and manometry
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Barium swallow
 
 
 
Weight loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increase LES pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rings
 
 
 
Webs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rapid
 
 
 
Slow
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Achalasia
 
 
 
DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cancer
 
 
 
Strictures/GERD
 
 
 
 
 
 

























































Preferred Table

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
Plummer-Vinson syndrome
  • Gradual
+ - Non progressive +/- - Normal
Barium esophagogram (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>)
{{#ev:youtube|HFfsTgsB6Pg}}

Triad of

Esophageal stricture
  • Gradual
  • Sudden onset
+ - Progressive +/- +/- Normal
  • Sacculations
  • Fixed transverse folds
  • Esophageal intramural pseudodiverticula   
Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 23008
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Diffuse esophageal spasm
  • Sudden
+ + Non progressive + + Normal
  • Nonperistaltic and nonpropulsive contractions
  • Corkscrew or rosary bead esophagus
Barium swallow appearance of DES
Source:By Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)
  • Inconclusive
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Achalasia
  • Gradual
+ + Non progressive +/- - Normal
  • "Bird's beak" or "rat tail" appearance
  • Dilated esophageal body
  • Air fluid level (absent peristalsis)
  • Absence of an intragastric air bubble
Case courtesy of Dr Mario Umana, Radiopaedia.org, rID: 38071
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  • Residual pressure of LES > 10 mmHg
  • Incomplete relaxation of the LES
  • Increased resting tone of LES
  • Aperistalsis
Systemic sclerosis
  • Gradual
+ + Progressive +/- + Normal
  • Dysmotility
  • Peptic stricture (advanced cases)
Positive serology for
Zenker's diverticulum
  • Gradual
+ - +/- - Normal
Radiopaedia.org">"Zenker diverticulum | Radiology Case | Radiopaedia.org".</ref>
  • Exclude the presence of SCC
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  • CT & MRI shows out-pouching over the posterior esophagus in the Killian's triangle
Esophageal carcinoma
  • Gradual
+ + Progressive + +/- Normal
Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f
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  • CT and PET scan is an optional test for staging of the disease
Stroke

(Cerebral hemorrhage)

  • Sudden
+ + Progressive + +/- Impaired
Motor disorders

(Myasthenia gravis)

  • Gradual
+ + Progressive +/- Normal
  • Stasis in pharynx and pooling in pharyngeal recesses
  • Anti–acetylcholine receptor antibody test
GERD
  • Gradual
  • Sudden onset
+ - Progressive +/- + Normal
Esophageal web
  • Gradual
+ +/- Progressive - +/- Normal
  • Smooth membrane not encircling the whole lumen

Manifestations Diagnostic tools
Achalasia
  • Dysphagia for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively[2]
  • Regurgitation of undigested food occurs in 76-91% of patients[2]
  • Cough mainly when lying down in 30%[2]
  • 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.
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.[3]
  • 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.
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 carcinoma
  • Dysphagia
  • Odynophagia- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty[4]
  • Weight loss
  • Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character
  • Nausea and vomiting[4]
  • Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2587715
Corckscrew esophagus
  • Retrosternal chest pain that presents with or without food intake.[5]
  • The condition is not progressive and not causing complications.[6]
  • Barium swallow shows the characteristic corckscrew appearance of the esophagus.
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.[7]
  • Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention.[8]
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:[9][10][11]
  • 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:

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>)

References

  1. Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  2. 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.
  3. 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. 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.
  5. Matsuura H (2017). "Diffuse Esophageal Spasm: Corkscrew Esophagus". Am. J. Med. doi:10.1016/j.amjmed.2017.08.041. PMID 28943381.
  6. Lassen JF, Jensen TM (1992). "[Corkscrew esophagus]". Ugeskr. Laeg. (in Danish). 154 (5): 277–80. PMID 1736462.
  7. 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.
  8. Shami VM (2014). "Endoscopic management of esophageal strictures". Gastroenterol Hepatol (N Y). 10 (6): 389–91. PMC 4080876. PMID 25013392.
  9. 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.
  10. Chisholm M (1974). "The association between webs, iron and post-cricoid carcinoma". Postgrad Med J. 50 (582): 215–9. PMC 2495558. PMID 4449772.
  11. 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.

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