Gastroenterology and Liver

Esophageal Disorders: Diagnosis and Management

Esophageal disorders, including gastroesophageal reflux disease (GERD), Barrett's esophagus, and esophageal motility disorders, present significant diagnostic and therapeutic challenges. Accurate diagnosis is crucial for effective management and preventing complications. Advanced diagnostic techniques, such as high-resolution manometry (HRM) and pH monitoring, have improved the evaluation of esophageal motility and acid exposure, aiding in the diagnosis of conditions like achalasia and GERD.

Management of GERD involves lifestyle modifications, pharmacologic therapy, and, in refractory cases, surgical interventions. Proton pump inhibitors (PPIs) are the mainstay of pharmacologic treatment, reducing acid secretion and alleviating symptoms. Surgical options, such as laparoscopic fundoplication, are considered for patients with persistent symptoms despite medical therapy or those with complications like Barrett's esophagus. Endoscopic therapies, including radiofrequency ablation and endoscopic mucosal resection, are effective for treating Barrett's esophagus and preventing progression to esophageal adenocarcinoma.

Esophageal motility disorders, such as achalasia, are managed with a combination of medical, endoscopic, and surgical approaches. Endoscopic treatments, including pneumatic dilation and peroral endoscopic myotomy (POEM), have revolutionized the management of achalasia, offering effective and minimally invasive options. Botulinum toxin injections are another therapeutic option for certain motility disorders. The continuous evolution of diagnostic and therapeutic techniques is enhancing the management of esophageal disorders, improving patient outcomes and quality of life.