Gold standard test for diagnosing GERI):

Ref: Harrisons Principles of Internal Medicine, 18th ed, pg 2428Explanation:GERD:Heartburn & regurgitationCough, dental erosions, arrhythmias can occurComplications- Peptic stricture, Barrets esophagus , adenocarcinoma (20 fold higher in Barrets)Confirmatory test is 24-48 hr pH monitoring to show pH<4 for >5%of durationSensitivity can be increased by impedence manometryEndoscopy can be normal in reflux many timesEsophageal manometry used to diagnose motility disorders-achalasia, diffuse esophageal spasmEndoscopic ultrasound (EL'S) - to stage esophageal cancer, to diagnose dysplasia in Barret's & for submucous tumors.Esophagitis - stricture - Barret's esophagus - adenocarcinoma50% of esophageal ca is adenocarcinomaEsophageal dysphagia: causesSchatzki ringWebGERDAchalasiaDESSclerodermaNeoplasmPeptic strictureEsophagitis- pill, infection, radiationCrohn's, Behcet'sBullous pemphigus, lichen planusSchatzki ring- Distal esophageal mucosal ring (B ring) with lumen diameter < 13mm, causing intermittent dysphagia for solid foods ysteakhouse syndrome)Zenkers diverticulum- false, hypopharyngeal diverticula at the Killians triangle due to stenotic cricopharyngeus muscle (upper esophageal sphincter)Barium swallows inDES- corkscrew esophagusAchalasia-dilated esophagus, tapering at LES beak like appearanceTylosis plantaris, pluminer Vinson, Selenium, molybdenum, Zinc, Vit A deficiencies = associated with esophageal cancerManometry- Most sensitive test for Achalasia