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Primary symptoms of underlying esophageal disorders, most often due to mechanical or motility disturbance, include heartburn, dysphagia, odynophagia, and regurgitation.

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Indications for endoscopy are presence of weight loss, upper gastrointestinal bleeding, dysphagia, odynophagia, chest pain, poor response to therapy, and for evaluation for Barrett’s esophagus.

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Esophageal manometry measures coordination of intraluminal pressure activities of the three functional regions of the esophagus: the lower esophageal sphincter, esophageal body, and upper esophageal sphincter; it is used in patients with dysphagia and noncardiac chest pain suggesting motility disorders.

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Indications for 24-hour pH monitoring are to document excessive acid reflux in patients with suspected gastroesophageal reflux disease without endoscopic findings and to assess the efficacy of medical or surgical therapy.

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Development of the wireless pH monitoring capsule has improved sensitivity for detecting reflux events through prolonged monitoring, improved patient compliance, reduced impairment of patients’ daily activity, and decreased likelihood of catheter movement during the study.

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Multichannel intraluminal impedance probes measure both acidic and nonacidic reflux of liquid or gas by measuring the resistance to current flow between adjacent electrodes.

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Empiric therapy for classic gastroesophageal reflux disease is recommended. Additional studies are considered in patients with no response and in patients with dysphagia, odynophagia, weight loss, chest pain, or choking.

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Antireflux surgery is not advised in patients whose reflux disease is unresponsive to proton pump inhibitor therapy and who have no evidence of esophageal acid exposure or nonacid regurgitation.

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Patients with Barrett’s esophagus require continued endoscopic surveillance to detect the development of dysplasia and adenocarcinoma.

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The cardinal symptom of infectious esophagitis, commonly found in immunosuppressed patients, is odynophagia.