Diagnosing Esophageal Irritation and Scarring: Key Tests and What They Reveal

Evaluation of esophageal mucosal injury relies on a combination of endoscopic visualization, functional testing, and histopathology.

Gold Standard: Upper Endoscopy (EGD)

A flexible endoscope allows direct inspection of the esophageal lining. Findings include:

• Erosions/ulcers (graded by Los Angeles or Savary-Miller classification)
• Strictures (narrowing from chronic scarring)
• Barrett's esophagus (metaplastic columnar epithelium)
• Eosinophilic infiltrates (rings, furrows, exudates)

Targeted biopsies confirm diagnosis and rule out dysplasia/malignancy.

Complementary Tests

Clinical Workflow

1. Alarm symptoms (dysphagia, weight loss, bleeding) → urgent EGD.
2. Typical GERD without alarms → empiric PPI trial; if inadequate response → EGD +/− pH testing.
3. Suspected eosinophilic esophagitis → EGD with biopsies (even if mucosa appears normal).
4. Pre-surgical evaluation for fundoplication → manometry + pH testing mandatory.

Test selection should be guided by the clinical question. A gastroenterologist can tailor the diagnostic pathway.

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Test	Primary Utility
Barium Esophagram (Upper GI Series)	Structural outline: strictures, hiatal hernia, diverticula, motility grossly
Esophageal Manometry	Pressure topography: peristalsis integrity, LES pressure, achalasia, spastic disorders
24-hr pH/Impedance Monitoring	Acid/non-acid reflux quantification; symptom-reflux correlation
Biopsy (during EGD)	Histology: eosinophilic esophagitis, Barrett's, infection, neoplasia