Gravity, esophageal peristalsis, and saliva pH help esophageal clearance. Nonsteroidal anti-inflammatory drugs, tetracycline, quinidine, and other drugs can damage esophageal mucosa. High-fat meals and medical conditions such as diabetes and Raynaud's phenomenon can delay gastric emptying.
Symptoms worsen with reclining.
Atypical symptoms include wheezing, hoarseness, chest pains, chronic cough, earache, recurrent aspiration, and sore throat. Conduct an esophageal manometry when antireflux surgery is planned for patients with recurrent dysphagia with normal endoscopy. Check serum gastrin levels to rule out Zollinger-Ellison syndrome, for secretory analysis, or for patients unresponsive to treatment steps 1 through 4. Barium esophagography is sometimes used for patients with severe dysphagia to identify strictures prior to endoscopy. Lifestyle modification is the cornerstone of management.