B32. Diagnostic modalities of an esophageal disease.

Page created on October 19, 2021. Not updated since.

Investigations for gastroesophageal reflux disease

Many modalities may be used in GERD:

  • Upper endoscopy
  • Oesophageal pH-metry
  • Oesophageal impedance
  • Bilitec

Oesophageal impedance measures the flow of reflux into the oesophagus. It’s often measured simultaneously as pH-metry, which measures pH over 24 hours using a transnasal catheter.

Bilitec detects bilirubin in the oesophagus and is a test for biliary reflux.

Investigations for oesophageal motility disorders

  • Oesophageal manometry
  • Barium swallow

Manometry is the gold standard for diagnosis of motility disorders. It uses a transnasal catheter with pressure sensors to analyse the peristaltic waves in the oesophagus.

Barium swallow may show characteristic findings of diffuse oesophageal spasm (DES) or achalasia.

Investigations for oesophageal cancer

The diagnosis of oesophageal cancer is histologic, and a biopsy is obtained by upper endoscopy (oesophagoscopy).

After the diagnosis is made, the most important is to determine the tumour’s resectability. Endoscopic ultrasound (EUS) is the preferred method for this, as it’s the most accurate technique for staging the tumour locally (T) and regionally (N). EUS can separate T1A and T1B stages.

CT and PET-CT are also important in the evaluation of oesophageal cancer but somewhat out of the scope of the topic. For more information on oesophageal cancer, see topic B21, 22.

Leave a Reply

Inputting your name is optional. All comments are anonymous.

This site uses Akismet to reduce spam. Learn how your comment data is processed.