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Copyright ©The Author(s) 2021.
World J Gastroenterol. Apr 28, 2021; 27(16): 1751-1769
Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1751
Table 1 Esophageal disorders with gastroesophageal reflux disease-like symptoms
DiagnosisDefinitionClinical symptomsPathophysiologyDiagnostic evaluation
Structural disorders
GERDSymptoms and complications secondary to the reflux of gastic contents above the lower esophageal sphincter[5]Regurgitation, reflux, dysphagia, retrosternal non-cardiac chest pain, globus sensation, extra esophageal symptomsAbnormal transient LES relaxation, LES dysfunction secondary to anatomic abnormality such as hiatal herniaUpper endoscopy, high resolution manometry, ambulatory pH testing, ambulatory impedance testing
Weak acid refluxSymptoms secondary to reflux of gastric contents above the LES with pH ranging from 4-7[32]Reflux, regurgitation, non-cardiac chest painPersistent reflux with pH from 4-7 due to transient LES relaxationpH studies - on maximum PPI therapy
Eosinophilic esophagitisPresence of symptoms of esophageal dysfunction such as reflux or dysphagia, eosinophilic inflammation on esophageal biopsy with ≥ 15 eosinophils per high power field, and exclusion of other disorders with similar presentations[81]Dysphagia, reflux, non-cardiac chest painEosinophil mediated inflammatory response in the esophagus secondary to allergenic antigensUpper endoscopy with biopsy
Motility disorders
AchalasiaElevated IRP > 15 mmHg and absence of normal peristalsis[44]Dysphagia, regurgitation, non-cardiac chest painFailure of LES relaxation and absence of normal peristalsisHigh resolution manometry, upper endoscopy, barium studies
Absent peristalsisSystemic symptoms with aperistalsis with failed peristalsis on 100% of swallows[49]Reflux, dysphagia, non-cardiac chest painLower esophageal collagen deposition leading to LES dysfunctionHigh resolution manometry, autoimmune antibody workup
Distal esophageal spasmNormal IRP and ≥ 20% premature contractions with DCI > 450 mmHg[44]Dysphagia, regurgitation, reflux, non-cardiac chest painImpaired inhibition and coordination of esophageal muscle contractionHigh resolution manometry, Barium swallow “corkscrew esophagus”
Hypercontractile esophagusMinimum of 2 swallows with DCI > 8000 mmHg[44]Retrosternal non-cardiac chest pain, dysphagia, regurgitationIncreased contraction of esophageal smooth muscleUpper endoscopy, barium studies, high resolution manometry
Esophagogastric junction outflow obstructionElevated median IRP > 15 mmHg with evidence of peristalsis on swallows[44]Dysphagia, reflux, regurgitationImpairment of esophagogastric junction relaxation with normal or weakened esophageal peristalsisHigh resolution manometry, needs to be confirmed with further studies such as barium swallow or endoflip, must rule out artifact that can be seen with a hiatal hernia
Opioid induced esophageal dysfunctionPresence of symptoms of esophageal dysfunction with manometric evidence of esophageal dysmotility in the presence of chronic opioid use[55]Regurgitation, dysphagia, refluxOpioid induced blocking of esophageal inhibitory signals leading to increased spastic contraction and decreased LES relaxationClinical history, high resolution manometry
Gastroparesis Presence of symptoms such as nausea, vomiting, and early satiety with mechanical obstruction ruled out and evidence of delayed gastric emptying on testing[82]Nausea, reflux, regurgitation, early satiety, abdominal pain and bloatingMultiple etiologies caused slowed peristalsis and delayed gastric emptyingGastric emptying study
Functional disorders
Functional heartburnPresence of burning retrosternal discomfort, no symptoms relief on optimal therapy, absence of GERD or EOE as cause of symptoms, and absence of major motility disorder[83]Reflux, regurgitation, globus sensationPotentially secondary to increased esophageal sensitivityUpper endoscopy, high resolution manometry, pH-impedance studies
Reflux hypersensitivityPresence of retrosternal chest pain, normal endoscopy and absence of EOE, absence of major motility disorder, and symptom association with reflux events with normal acid exposure on pH-impedance tests[83]RefluxHypersensitization of esophageal nerve endings leading to pain secondary to physiologic esophageal stimuliUpper endoscopy, high resolution manometry, pH-impedance studies
RuminationMust include both persistent regurgitation of recently ingested food with subsequent spitting or re-mastication, and regurgitation that is not preceded by retching[83]Regurgitation (frequently after meals), refluxBehavioral contraction of abdominal muscles leading to increased intragastric pressure and refluxClinical history, high resolution manometry, pH-impedance studies
Supragastric belchingPresence of frequent repetitive belching, no established clinical correlate for gastric belching, and evidence of supragastric origin on impedance testing[83]Frequent belching, reflux, regurgitation, globus sensationBehavioral swallowing of air without LES relaxationClinical history, high resolution manometry, pH-impedance studies