Esophageal Disease and Testing PDF

Preface

Techniques to investigate the esophagus have improved and expanded to meet the need of an explosion in the prevalence and interest in esophageal diseases, notably gastroesophageal reflux disease and adenocarcinoma at the cardia. Newer techniques have evolved to improve the understanding of the pathophysiology of esophageal diseases, and in many respects reinforce existing concepts rather than making them obsolete.

An adequate investigation of esophageal anatomy and function requires radiological, endoscopic, and manometric techniques. The results of these tests although not always conclusive, provide sufficient comprehension of the patients' complaints to at least choose the right direction for effective surgical management. Often insights are obtained that could not have been thought of had the tests not been done. The more detailed our understanding, the more effective our therapy. Radiology of the esophagus provides visualization of any structural changes, such as strictures, cancer, diverticula, and hernias. Moreover, the extent of the abnormality is more clearly defined before the passage of an endoscope. Endoscopy is essential to detect superficial lesions, Barrett's esophagus, early cancer, and to provide a grading of the structural geometry of the cardia. Ineffective esophageal body motility, and/or a hypo- or hypertensive lower esophageal sphincter can only be diagnosed by manometric studies. Failure to do manometry on unexplained dysphagia may preclude a patient from the benefits of appropriate treatment.

Esophageal impedance studies are useful in defining bolus transport, and to clarify the nature of regurgitation. Combined with a pH probe, impedance studies can distinguish between acid and alkaline reflux episodes. The Bilitec probe may be worthwhile in some situations to distinguish between bile and nonbilious alkaline fluid such as saliva, whereas the recent introduction of a tubeless pH probe makes the 24 h pH monitoring comfortable for the patient.

This book has been compiled by a group of clinicians who have made dedicated studies on the esophagus for many years, and has been compiled to give a clear description about the use and interpretation of each test.

We hope that you will enjoy reading this book as much as we have enjoyed compiling it.