CLINICAL SYMPTOMS OF ESOPHAGEAL DISEASE



Dysphagia, the sensation that a food bolus ar­rests (”sticks”) during swallowing, indicates esophageal disease, and the patient can often in­dicate the exact site. Dysphagia may be due to mo­tility disorders or to narrowing of the esophageal lumen by benign or malignant disease (Table 38-1). A motility disorder is more likely if dysphagia occurs with both liquids and solids, or if the patient can force the bolus down by altering pos­ture, performing a Valsalva maneuver, or repeated swallowing.

Heartburn (pyrosis), a common esophageal symptom, is a burning pain that radiates up be­hind the sternum. It is due to reflux of acidic gas­tric contents into the esophagus. It is often re­lieved by antacids, is precipitated by bending over or lying down, and may be accompanied by re­gurgitation of souror bittertasting material. Noc­turnal reflux and regurgitation may present as re­current aspiration pneumonia, wheezing, or hoarseness.

Odynophagia, or pain on swallowing, is usually associated with esophageal obstruction or mu­cosal disease such as reflux esophagitis, radiation-induced damage, or infection by viral or fungal agents.
Severe substernal chest pain that is often in­distinguishable from angina pectoris may result from abnormal esophageal motor function, such as diffuse esophageal spasm.