Which studies are included in the initial evaluation of esophagitis?

Updated: May 28, 2020
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Laboratory tests are usually unhelpful unless complications are present (eg, upper gastrointestinal [GI] hemorrhage). Routine radiography is not indicated unless complications (eg, perforation, obstruction, bleeding) are suspected. Electrocardiography (ECG) and troponin or other cardiac markers are needed when acute coronary syndrome is in the differential diagnosis.

A double-contrast esophageal barium study (esophagography) is recommended as the initial imaging study in patients presenting with dysphagia. However, a case can be made for initial upper endoscopy (esophagogastroduodenoscopy [EGD]) because this approach would reveal more diagnostic information (eg, inflammatory characteristics, ability to obtain samples for pathologic examination, cytologic examination, and viral and bacterial cultures).

The authors do not recommend barium studies for patients with absolute dysphagia or odynophagia. Upper endoscopy would be recommended under these circumstances. The authors view barium studies and upper endoscopy as complementary rather than competing tests in the evaluation of patients with dysphagia.

Diagnosis of metastatic cancer is best made by means of barium contrast radiography and computed tomography (CT) scanning.

See Pediatric Esophagitis for complete information on this topic.

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