What is the role of upper endoscopy (esophagogastroduodenoscopy) in the diagnosis of esophagitis?

Updated: May 28, 2020
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Direct upper endoscopy (ie, esophagogastroduodenoscopy [EGD]) allows mucosal visualization and procurement of mucosal biopsies and brushings (see the image below). It is a useful procedure in evaluating the degree of mucosal damage and is indicated in patients with hematemesis, heme-positive stools, or suspected esophageal obstruction. [1] Definitive diagnosis of infectious esophagitis requires esophagoscopy with biopsy for histologic and microbiologic evaluation. [7]

Peptic esophagitis. A rapid urease test (RUT) was Peptic esophagitis. A rapid urease test (RUT) was performed on the esophageal biopsy sample. The result was positive for Helicobacter pylori.

Upper endoscopy is indicated in patients older than 50 years with new onset of symptoms, in those with features suggesting more serious disease (eg, abdominal mass, anemia, vomiting, dysphagia), and in patients in whom repeated trials of medical therapy have failed. Endoscopy may be indicated on an emergency basis in cases of upper GI hemorrhage, obstruction, or perforation. Endoscopy with biopsy and cultures is required for the diagnosis of infectious esophagitis.

EGD is preferred in patients with odynophagia because this is a specific symptom of esophagitis. EGD is the main diagnostic tool used for esophagitis. As noted earlier, upper endoscopy should be thought of as complementary to, rather than competing with, barium studies in the evaluation of patients with dysphagia.

A wide variety of endoscopic findings are possible, depending on the underlying cause. For instance, in patients with tuberculous esophagitis, esophageal symptoms may result from direct extension from adjacent mediastinal structures. EGD reveals shallow ulcers, heaped-up lesions mimicking neoplasia, and extrinsic compression of the esophagus. Specimens should be sent for acid-fast stains and mycobacterial culture.

In patients with graft versus host disease, generalized desquamation is visible on EGD.

In patients with metastatic cancer, EGD is used to exclude primary esophageal cancer.

In patients with pill esophagitis, EGD findings range from reddened edematous mucosa to small superficial ulcers to large ulcers with heaped up inflamed margins, often with exudate.

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