Key Points

• Accurate symptom assessment with a thorough clinical history is the first step in diagnosis and treatment of esophageal disease.
• In Western societies, GERD is the most common symptomatic esophageal disorder.
• Symptoms of benign and malignant disease can overlap, however certain symptoms mandate further workup for underlying pathology.

The esophagus is responsible for movement of ingested food and saliva from the pharynx to the stomach and prevention of reflux of gastric contents. Unlike other portions of the gastrointestinal tract, the esophagus has no known digestive, absorptive, immunologic, hormonal, or secretory functions. Despite the apparent simplicity of its responsibilities, derangements in esophageal structure or function can severely impact the quality of a person’s life. Minor derangements are relatively common, leading to intermittent symptoms that are easily controlled with dietary or lifestyle modifications. More severe symptoms may require medications designed to modulate foregut function. Severe symptoms may require intensive medical management or remedial surgery designed to improve foregut structure or function. Finally, in cases of advanced or end-stage benign esophageal disease or foregut malignancy, esophagectomy may be required with appropriate reconstruction.

Accurate symptom assessment with a thorough clinical history in the evaluation of esophageal disease is central to management: decisions regarding surgical intervention are generally determined by the nature and severity of symptoms, placed in the context of any underlying anatomic or physiologic derangements, the inherent risks of treatment, and the probability of relief of each symptom. Esophageal disease can be divided into three primary categories: benign disease, malignancy, and post-surgical symptomatology. Each of these types of disease can present with overlapping spectrums of esophageal symptoms. This chapter will focus on the clinical manifestations of esophageal disease seen in each of these three categories, classification of symptomatology as typical or atypical, and the distinguishing features of a patient’s presentation that should raise concern and prompt further workup.