Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic<unk>  and can be a cause of dysphagia or difficulty swallowing. The diagnosis of<unk>  is usually made when typical symptoms are present.<unk>  can be present in people without symptoms and the diagnosis requires both symptoms or complications and<unk>  of stomach content. Other investigations may include esophagogastroduodenoscopy (EGD). Barium swallow X-rays should not be used for diagnosis. Esophageal manometry is not recommended for use in the diagnosis, being recommended only prior to surgery. Ambulatory esophageal pH monitoring may be useful in those who do not improve after PPIs and is not needed in those in whom Barrett's esophagus is seen. Investigation for H. pylori is not usually needed. The current gold standard for diagnosis of<unk>  is esophageal pH monitoring. It is the most objective test to diagnose the<unk><unk>  and allows monitoring<unk>  patients in their response to medical or surgical treatment. One practice for diagnosis of<unk>  is a short-term treatment with proton-pump inhibitors, with improvement in symptoms suggesting a positive diagnosis. Short-term treatment with proton-pump inhibitors may help predict abnormal 24-hr pH monitoring results among patients with symptoms suggestive of<unk> . Endoscopy Endoscopy, the looking down into the stomach with a fibre-optic scope, is not routinely needed if the case is typical and responds to treatment. It is recommended when people either do not respond well to treatment or have alarm symptoms, including dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes. Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding<unk> , to evaluate the possible presence of dysplasia or Barrett's esophagus. Biopsies performed during gastroscopy may show: * Edema and basal hyperplasia (nonspecific inflammatory changes) * Lymphocytic inflammation (nonspecific) * Neutrophilic inflammation (usually due to<unk>  or Helicobacter gastritis) * Eosinophilic inflammation (usually due to<unk> : The presence of intraepithelial eosinophils may suggest a diagnosis of eosinophilic esophagitis (EE) if eosinophils are present in high enough numbers. Less than 20 eosinophils per high-power microscopic field in the distal esophagus, in the presence of other histologic features of<unk> , is more consistent with<unk>  than EE. * Goblet cell intestinal metaplasia or Barrett's esophagus * Elongation of the papillae * Thinning of the squamous cell layer * Dysplasia * Carcinoma<unk>  changes that are not erosive in nature lead to "nonerosive<unk><unk> ". Severity Severity may be documented with the Johnson-DeMeester's scoring system: 0 - None 1 - Minimal - occasional episodes 2 - Moderate - medical therapy visits 3 - Severe - interference with daily activities Differential diagnosis Other causes of chest pain such as heart<unk>  should be ruled out before making the diagnosis. Another kind of acid<unk> , which causes respiratory and laryngeal signs and symptoms, is called laryngopharyngeal<unk>  (LPR) or "extraesophageal<unk><unk> " (EERD). Unlike<unk> , LPR rarely produces heartburn, and is sometimes called silent<unk> . Differential diagnosis of<unk>  can also include dyspepsia, peptic ulcer<unk> , esophageal and gastric cancer, and food allergies.
Gastroesophageal reflux disease
Esophageal cancer
Laryngopharyngeal reflux
Angina
Geophagia
Peptic ulcer disease
Peanut allergy
Esophageal spasm