Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic gastroesophageal reflux disease and can be a<unk>  of dysphagia or difficulty swallowing. The diagnosis of GERD is usually made when typical symptoms are present. Reflux can be present in people without symptoms and the diagnosis requires both symptoms or complications and reflux 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 GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment. One practice for diagnosis of GERD 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 GERD. Endoscopy Endoscopy, the looking down into the stomach with a fibre-optic scope, is not routinely needed if the<unk>  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 GERD, 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 reflux or Helicobacter gastritis) * Eosinophilic inflammation (usually due to reflux): 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 GERD, is more consistent with GERD than EE. * Goblet cell intestinal metaplasia or Barrett's esophagus * Elongation of the papillae * Thinning of the squamous cell layer * Dysplasia * Carcinoma Reflux changes that are not erosive in nature lead to "nonerosive reflux disease". 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<unk> s of chest pain such as heart disease should be ruled out before making the diagnosis. Another kind of acid reflux, which<unk> s respiratory and laryngeal signs and symptoms, is called laryngopharyngeal reflux (LPR) or "extraesophageal reflux disease" (EERD). Unlike GERD, LPR rarely produces<unk> , and is sometimes called silent reflux. Differential diagnosis of GERD can also include dyspepsia, peptic ulcer disease, esophageal and gastric cancer, and food allergies.
medical cause of Heartburn
caption of Plummer–Vinson syndrome
symptom of Esophageal cancer
symptom of Gastroesophageal reflux disease
medical cause of Chest pain
medical cause of Gastritis
complications of Esophageal varices
symptom of Hiatal hernia