What are the symptoms of esophageal diseases?

Symptoms of Esophageal Diseases

The most common symptoms of esophageal diseases include dysphagia (difficulty swallowing), odynophagia (painful swallowing), chest pain, heartburn, regurgitation, and food impaction, with presentation varying by specific condition and patient age. 1

Common Symptoms Across Esophageal Conditions

Primary Symptoms

• Dysphagia - Difficulty swallowing, ranging from mild to severe
• Odynophagia - Pain while swallowing
• Chest pain - May mimic cardiac pain, can occur with or without swallowing
• Food impaction - Food becoming stuck in the esophagus
• Heartburn/regurgitation - Reflux of gastric contents into the esophagus

Secondary Symptoms

• Vomiting/emesis
• Abdominal pain
• Weight loss
• Malnutrition

Age-Related Symptom Presentation

Children

• Feeding difficulties/refusal - Especially in infants and toddlers 1
• GERD-like symptoms - Heartburn and regurgitation (5-82% of cases) 1
• Emesis - Reported in 8-100% of cases 1
• Abdominal pain - Reported in 5-68% of cases 1
• Dysphagia - More common in older children (16-100% of cases) 1
• Food impaction - Reported in 10-50% of cases 1
• Failure to thrive - Reported in 5-19% of cases 1
• Chest pain - Reported in 17-20% of cases 1

Adults

• Dysphagia - Most common symptom (29-100% of cases) 1
• Food impaction - Very common (25-100% of cases) 1
• GERD-like symptoms - Less common than in children (7-100% of cases) 1
• Chest pain - Reported in 1-58% of cases 1
• Abdominal pain - Reported in 3-25% of cases 1

Symptoms by Specific Esophageal Conditions

Gastroesophageal Reflux Disease (GERD)

• Heartburn - Burning sensation in chest/retrosternal area 1
• Regurgitation - Backflow of stomach contents into mouth 1
• Chest pain - May mimic cardiac pain 1
• Dysphagia - Can develop with chronic disease 2

Eosinophilic Esophagitis (EoE)

• Dysphagia - Primary symptom in adults 1
• Food impaction - Responsible for up to 50% of cases requiring endoscopic removal 1
• GERD-like symptoms - Often unresponsive to acid blockade 1
• Chest pain - Can be present with or without swallowing 1, 3
• Compensatory behaviors - Eating slowly, cutting food into small pieces, avoiding certain food textures 1

Esophageal Candidiasis

• Dysphagia - Cardinal symptom 4
• Odynophagia - Cardinal symptom 4
• Retrosternal chest pain - With or without swallowing 4
• Food avoidance behavior - Especially difficult-to-swallow textures 4
• Drinking large volumes of water with meals - Compensatory behavior 4

Esophageal Motility Disorders (including Achalasia)

• Dysphagia - For both solids and liquids 5, 6
• Chest pain - Often severe 5, 6
• Regurgitation - Undigested food 6
• Weight loss - In advanced cases 6

Compensatory Behaviors to Watch For

Patients with esophageal diseases often develop compensatory behaviors that may mask symptoms:

• Eating slowly
• Cutting food into small pieces
• Avoiding certain food textures (particularly bread and meat)
• Drinking excessive liquids with meals
• Repeated throat clearing
• Avoiding eating in social settings

Diagnostic Considerations

When evaluating patients with suspected esophageal disease:

1. Consider age-specific presentations - Children often present with feeding difficulties and GERD-like symptoms, while adults more commonly present with dysphagia and food impaction 1

2. Recognize symptom overlap - Esophageal symptoms can mimic cardiac conditions; approximately 10-20% of outpatients with chest pain have a gastrointestinal cause 1

3. Watch for atypical presentations - Some patients may have minimal symptoms despite significant disease 1

4. Be alert to alarm symptoms - Dysphagia, odynophagia, gastrointestinal bleeding, unexplained iron deficiency anemia, weight loss, and recurrent vomiting warrant prompt evaluation (usually within 2 weeks) 1

5. Consider endoscopy - When esophageal disease is suspected, especially with dysphagia or food impaction 1

Common Pitfalls in Diagnosis

• Misattributing symptoms to GERD - Many esophageal conditions initially present with GERD-like symptoms but fail to respond to acid suppression 1
• Overlooking EoE - Consider in patients with dysphagia or food impaction, especially in young males with atopic conditions 1, 3
• Failing to recognize compensatory behaviors - Patients often adapt eating habits to manage impaired esophageal function 1
• Misdiagnosing chest pain - Esophageal causes of chest pain can mimic cardiac conditions 1
• Delayed diagnosis - Many adults with esophageal conditions have long-standing symptoms before diagnosis; average delay in diagnosis of EoE is 4.6 years 1