Differentials
Benign stricture
SIGNS / SYMPTOMS
Usually associated with a long history of heartburn and slowly progressive dysphagia.
INVESTIGATIONS
Esophagogastroduodenoscopy (EGD) shows stricture of benign etiology.
Achalasia
SIGNS / SYMPTOMS
Long history of regurgitation with no history of heartburn. May be clinically indistinguishable from esophageal 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.
EGD has low sensitivity for the diagnosis of achalasia, and is often reported to be normal in early achalasia.
Esophageal manometry shows incomplete relaxation of the lower esophageal sphincter.
Barrett esophagus
SIGNS / SYMPTOMS
Longstanding reflux. Dysphagia is rare.
INVESTIGATIONS
EGD and biopsy will differentiate between benign intestinal metaplasia, dysplasia, and actual invasive cancer.
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