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## Heartburn - Substernal burning-type discomfort - Beginning in the epigastrium and radiating upward - Often aggravated by meals, spicy or fatty foods, chocolate, alcohol, and coffee - Can be worse in the supine position ## Dysphagia - Difficulty swallowing - Non-specific term but arguably the m...

## Heartburn - Substernal burning-type discomfort - Beginning in the epigastrium and radiating upward - Often aggravated by meals, spicy or fatty foods, chocolate, alcohol, and coffee - Can be worse in the supine position ## Dysphagia - Difficulty swallowing - Non-specific term but arguably the most specific symptom of foregut disease - Sensation of difficulty in the passage of food from the mouth to the stomach - Can be divided into oropharyngeal and esophageal etiologies - **Oropharyngeal dysphagia:** characterized by difficulty transferring food out of the mouth into the esophagus, nasal regurgitation, and/or aspiration - **Esophageal dysphagia:** refers to the sensation of food sticking in the lower chest or epigastrium. This may or may not be accompanied by pain (odynophagia) that will be relieved by the passage of the bolus ## Chest Pain - Appropriately attributed to cardiac disease, is frequently secondary to esophageal pathology as well - **Heartburn (Pathologic) vs. Chest Pain:** Chest pain precipitated by meals, occurring at night while supine, non-radiating, responsive to antacid medication, or accompanied by other symptoms suggesting esophageal disease such as dysphagia or regurgitation should trigger the thought of possible esophageal origin ## Anti-reflux Mechanism | Characteristic | Measurement | |---|---| | Resting LES pressure | < 6 mmHg | | Its overall length | < 2cm | | Intra-abdominal length | < 1cm |