What is Barrett’s esophagus? Barrett’s esophagus is a metaplastic change in the lining of the normally squamous-lined esophagus that is recognized at endoscopy. As a result of gastroesophageal reflux disease, the esophagus is lined with intestinal metaplasia, a premalignant epithelium. How is Barrett’s esophagus diagnosed? The ultimate criterion for histologic diagnosis is the presence of [...]

Who is affected by pill-induced esophageal injury? Anyone of any age who ingests caustic pills is susceptible to pill-induced injury. Reported cases range from ages 5-89. Women outnumber men by a ratio of 1.5:1. It is not uncommon for pills to stick in a normal esophagus during transit. One study showed that 36 of 49 [...]

What is the incidence of esophageal cancer in the United States, and is it changing? Esophageal cancer is relatively infrequent in the United States. The annual incidence is <10 of 100,000 population, whereas in some areas of China the annual incidence is >100 of 100,000. Over the past three decades, the incidence of distal esophageal [...]

Define achalasia. The term achalasia (Greek = lack of relaxation) describes the pathophysiologic hallmark of the disease: failure of the lower esophageal sphincter (LES) to relax. This term has replaced the previous designation cardiospasm, which implies an exaggerated state of contraction. The second cardinal feature is aperistalsis of the body of the esophagus. However, LES [...]

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. [...]