When should the clinician consider an esophageal cause of chest pain? The concept of the esophagus as the origin of chest pain is not new. More than a century ago, Sir William Osler hypothesized that esophageal spasm represented one cause of chest pain in soldiers during wartime. A recent multicenter study reported that 55% of [...]

Which organisms are most commonly identified in esophageal infections? The most common etiologies are Candida albicans, herpes simplex virus (HSV), and cytomegalovirus (CMV). C. albicans and HSV can be seen in individuals with normal immunity, whereas CMV esophagitis is found in immunocompromised hosts. What are the typical presenting symptoms in patients with infectious esophagitis? Odynophagia [...]

What is gastroesophageal reflux disease (GERD)? How common is it? GERD is a pathologic condition of symptoms and injury to the esophagus caused by percolation of gastric or gastroduodenal contents into the esophagus. GERD is extremely common. One survey of hospital employees showed that 7% experienced heartburn daily, 14% experienced symptoms weekly, and 15% monthly. [...]

What is the most difficult substance to swallow? Water. Swallowing involves several phases. First, a preparatory phase involves chewing, sizing, shaping, and positioning of the bolus on the tongue. Then, during an oral phase, the bolus is propelled from the oral cavity into the pharynx while the airway is protected. Finally, the bolus is transported [...]

What is evidence-based medicine (EBM)? EBM is an approach to medicine that integrates the current best evidence, clinical expertise, and patient values to optimize clinical outcomes and quality of life. With EBM comes the recognition that intuition, unsystematic clinical experience, and speculative pathophysiologic rationale are insufficient grounds for clinical decision-making. Instead, EBM maintains that a [...]

Define sinusitis. Strictly speaking, sinusitis is inflammation of the mucosal lining of the paranasal sinuses secondary to many potential triggers. The term rhinosinusitis has been emphasized recently to highlight the importance of nasal cavity mucosal pathology in the overall disease process. Describe the pathophysiology of sinusitis. Mucosal edema of the paranasal sinuses is the basic [...]

Define rhinitis. Rhinitis is tissue inflammation and nasal hyperfunction that leads to nasal congestion/obstruction, rhinorrhea, nasal itching, and/or sneezing. Although rhinitis is generally not life-threatening, it is associated with significant loss of productivity and decreased quality of life. What pathophysiology underlies rhinitis? Nasal congestion arises from engorgement of blood vessels due to the effects of [...]