For more details refer Chapter 12.
Investigation of oesophageal disease is primarily by oesophagoscopy, which can be rigid or flexible. The rigid oesophagoscope is particularly useful for examination of the cervical oesophagus and when removing difficult foreign bodies such as bones, whereas the flexible oesophagoscope (generally a gastroscope is used) allows full examination of the oesophagus, even in patients with other problems such as kyphoscoliosis, and also examination of the stomach and duodenum for associated disease.
A barium swallow will show whether there is any hold up or abnormality in the oesophagus and if this is performed as a cine barium swallow, then a good idea of oesophageal motility is also obtained.
Oesophageal pressures may be measured using a perforated catheter with side holes and an electronic probe with microtransducers. The upper sphincter pressure is of the order of 70-108 mmHg and the lower sphincter pressure is 15-30 mmHg. Abnormal propulsion may be detected.
Measurements of oesophageal pH are useful in sorting out whether central chest pain is oesophageal or cardiac. If the pain is associated with episodes of low pH, this is a good indication that the pain is due to reflux oesophagitis.
Patients with oesophageal carcinoma should have a CT scan, which demonstrates if the tumour is infiltrating the adjacent structures and may also show paraoesophageal lymphadenopathy or distant metastases, particularly those in the liver. An intraoesophageal ultrasound examination is also a good way of estimating the depth of tumour in the wall of the oesophagus and the presence of paraoesophageal adenopathy. Special ultrasound probes are available which allow direct biopsy of the paraoesophageal glands.
If there is obstruction to swallowing it is called dysphagia, but if there is just pain on swallowing it is known as odonypha-gia. Oesophageal pain may be characteristic such as heartburn associated with acid reflux and associated hiatal hernia, but can also be quite obscure and mimic cardiac disease.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.