аЯрЁБс>ўџ ?Aўџџџ>џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅСq` №ПЂbjbjqPqP 4.::ЂџџџџџџЄ@@@@@@@T8<TЖ€€€€€€€€–˜˜˜˜˜˜$Эh5–М@€€€€€М@@€€бшшш€і@€@€–ш€–шшj@@Ж€t p§t+ГљЪv"‚”ч0Š,Ы˜:ЫЖЫ@ЖL€€ш€€€€€ММв€€€€€€€TTTФ TTT TTT@@@@@@џџџџ Symptoms of oesophageal disease These include: Dysphagia Odynophagia Heartburn or Pyrosis Regurgitation Non-Heartburn Chest Pain Waterbrash Bleeding Respiratory/Laryngeal symptoms Dysphagia: Dysphagia (from the Greek dys, meaning with difficulty, and phagia, meaning to eat) arises when transport of liquid or a bolus of food along the pharyngoesophageal conduit is impaired by mechanical obstruction or neuromuscular failure that disrupts peristalsis. Patients with dysphagia often complain of difficulty initiating a swallow or the sensation of food sticking or stopping in transit to the stomach. The cause is almost always organic rather than functional. It is important to differentiate oropharyngeal ("transfer") dysphagia from esophageal dysphagia OropharyngealOesophagealTrouble getting liquids or solids to the back of the throat or that food sticks in the back of the throatPatients with esophageal dysphagia most often describe a feeling of food sticking at the sternal notch or in the substernal regionCoughing, nasal regurgitation, or choking immediately after swallowing suggests oropharyngeal dysphagia. Greater difficulty swallowing liquids than solidsObserve the patient swallow in an attempt to determine the timing of the symptom; with OD, the sensation of dysphagia onsets several seconds after swallowing begins. Specific diseases associated with OPD include cerebrovascular disease, hypothyroidism, myasthenia gravis, muscular dystrophy, Parkinson's disease, and polymyositis. Neuromuscular disorders (eg, achalasia, diffuse esophageal spasm), many nonspecific motility abnormalities, and intrinsic or extrinsic obstructive lesions that may be benign or malignant.  The history can also be used to help differentiate structural from functional (i.e., motility disorders) causes of dysphagia. Dysphagia that is episodic and occurs with both liquids and solids from the outset suggests a motor disorder, whereas when the dysphagia is initially for solids, and then progresses with time to semisolids and liquids, one should suspect a structural cause (e.g., stricture). If such a progression is rapid and associated with significant weight loss, a malignant stricture is suspected. Symptom onset and progression Sudden onset of symptoms may result from a stroke (OPD) or food impaction (OD). Intermittent nonprogressive or slowly progressive dysphagia suggests a benign cause, such as a motility disorder or a stable peptic esophageal stricture. A history of prolonged heartburn may suggest peptic esophageal stricture, neoplasm, or esophageal ring. Exacerbating and relieving factors Greater difficulty swallowing liquids than solids is usually found in patients who have OD Dysphagia that progresses from solid to semisolid food or liquid in a brief period of time suggests esophageal stricture related to tumor. (Solid-food dysphagia consistently develops at a luminal diameter of <13 mm.) Equal dysphagia with solids and liquids is typical of esophageal motility disorders, which evolve slowly over months to years. Another characteristic of esophageal motility disorders, particularly esophageal spasm, is precipitation or worsening of dysphagia with consumption of very cold liquids or ice cream. Therefore inquire about eating habits to identify the source of dysphagia in patients who have learned methods to avoid symptoms. For example, patients with esophageal dysphagia may maintain good nutritional status by consuming nourishment as liquids or soft foods, chewing foods for prolonged periods, or drinking large amounts of water with meals to wash boluses down the esophagus. ODYNOPHAGIAThis refers to the sensation of pain on swallowing. When the pain is retrosternal, one should suspect nonreflux-induced forms of esophagitis, such as infection, radiation or pill-induced (chemical) injury. 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