Current methods to evaluate patients with
esophageal disease include
barium swallow with fluoroscopy, which is useful in demonstrating structural defects. Disordered motility is better evaluated with a cine-esophagram. Recent application of
radioisotopes has been useful in evaluation of
esophageal reflux and the post-treatment of
achalasia. Esophageal motility studies may evaluate lower esophageal sphincter and upper esophageal sphincter pressures and the response of the body of the esophagus to series of swallows. Since there is no "gold standard" for the evaluation of
reflux esophagitis, some of the tests designed to evaluate reflux and the patient's reaction to
acid in the esophagus include the
acid infusion test, the standard
acid reflux test, the
acid clearance test, and 24-hour pH monitoring. Endoscopy with either the flexible or the rigid instrument is important for the diagnosis of obstruction or
esophagitis and allows direct visualization of the esophagus. The treatment of
reflux esophagitis is discussed. The differential diagnosis of
dysphagia may include
achalasia,
diffuse esophageal spasm, and mechanical obstruction of the esophagus due to rings, webs,
strictures, and benign or malignant
tumors. The evaluation of
dysphagia should include radiologic as well as endoscopic evaluation. Treatment of obstruction varies according to the nature of the lesion. The
Mallory-Weiss syndrome or
bleeding from the mucosal tears of the gastroesophageal junction and
Boerhaave's syndrome, spontaneous
esophageal perforation, are two disorders associated with
vomiting. The
Mallory-Weiss syndrome usually resolves without specific
therapy, but a high index of suspicion is required for patients with
chest pain after
vomiting, as
spontaneous perforation necessitates immediate surgery. Most
diverticula need no treatment, but the
Zenker diverticulum, if symptomatic, should probably be surgically repaired.