Differential diagnosis of operable disease of the esophagus.

The time interval between ingestion and regurgitation and the stage of digestion in regurgitated food may be factors helpful in diagnosing disease of the esophagus. In most cases diagnosis can be made by x-ray alone, but where x-ray evidence is insufficient esophagoscopy is often justified.X-ray investigation for foreign bodies should include films of the neck. Cough is a common symptom of the presence of foreign bodies; obstruction may result from inflammation or edema. Perforation is most often caused by foreign bodies or by instrumentation. Esophagoscopy is hazardous in this condition and the findings are not likely to affect the course of treatment. Hiatal hernia, although probably occurring to some degree in 10 per cent of adults, seldom causes symptoms. Inflammation resulting from hernial obstruction may be mistaken for carcinoma. Esophageal carcinoma occurs most frequently in elderly persons and in men more than in women. Operation is necessary in many cases to prevent starvation. The postoperative mortality rate is as low as 11 to 24 per cent, and the proportion of five-year survivals is increasing. Achalasia or cardiospasm can generally be recognized by x-ray appearance. Bouginage is the usual treatment, but operation may be necessary. Late regurgitation of food is a common symptom of esophageal diverticulum. Atresia in a newborn infant is a dangerous condition. The effect of any of the four types of anomaly is the same: diversion of fluids from the stomach to the bronchi. Coughing, choking and cyanosis are the common symptoms in a newborn infant. Hematemesis may arise from a number of causes; esophageal hemorrhage most commonly is owing to varicosity from portal hypertension. Esophagoscopy is the quickest and safest method of determining whether hematemesis is of esophageal origin.