Differentials
Benign stricture
SIGNS / SYMPTOMS
Usually associated with a long history of heartburn and slowly progressive dysphagia.
INVESTIGATIONS
Oesophagogastroduodenoscopy (OGD) shows stricture of benign aetiology.
Achalasia
SIGNS / SYMPTOMS
Long history of regurgitation with no history of heartburn. May be clinically indistinguishable from oesophageal cancer.
INVESTIGATIONS
Upper gastrointestinal series shows a typical 'bird's beak' filling defect.
Caution is required to differentiate achalasia from pseudoachalasia (which is caused by a primary or secondary malignancy in the majority of patients). It is crucial therefore to follow up with an endoscopy for mucosal assessment and biopsy.
OGD has low sensitivity for the diagnosis of achalasia, and is often reported to be normal in early achalasia.
Oesophageal manometry shows incomplete relaxation of the lower oesophageal sphincter.
Barrett's oesophagus
SIGNS / SYMPTOMS
Long-standing reflux. Dysphagia is rare.
INVESTIGATIONS
OGD and biopsy will differentiate between benign intestinal metaplasia, dysplasia, and actual invasive cancer.
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