Section: Information In-depth
Diagnosis In-depth
A complete blood count (CBC) is most often within normal limits, however with severe inflammation/infection or anemia, one may expect to see an elevation in the white blood cell count or decrease in the red blood cell count, respectively.
A biochemical profile is needed to rule out other systemic disorders (liver, kidney disease) that may predispose to certain diseases associated with regurgitation.
A urinalysis is part of any complete baseline work-up.
Endocrine testing (ACTH stimulation test and thyroid assays) should be performed to rule out regurgitation associated with hypoadrenocorticism or hypothyroidism.
Antinuclear antibody (ANA) titers are performed to help rule out immune-mediated diseases (such as systemic lupus erythematosis) associated with regurgitation.
Thoracic (chest) radiographs (X-rays) are needed to evaluate the size/shape of the esophagus, assess for the presence of a foreign body, growth or megaesophagus and assess the lungs for the possibility of secondary pneumonia.
An acetylcholine receptor antibody test is a simple blood test performed on individuals with regurgitation secondary to megaesophagus to rule out myasthenia gravis. Although most often there are additional systemic signs associated with myasthenia, megaesophagus and regurgitation may be the only manifestations in certain cases.
Blood lead and/or organophosphate levels are run on patients who we suspect toxicities as underlying causes of regurgitation.
Electromyography (EMG) and muscle biopsies are recommended when a myopathy (muscle disorder) is suspected. These necessitate anesthesia, and are, therefore, associated with more risk than many of the other diagnostics described. An EMG is most often performed in a specialty hospital as specialized equipment and expertise are necessary.
An esophagram (barium contrast radiograph) may be indicated to rule out structural changes, such as a foreign body, growth, stricture.
Fluoroscopy helps assess the function of the esophagus. It evaluates the movement of solids and liquids through the esophagus. It is often necessary to have the procedure performed in a specialty facility as it requires expertise and special instrumentation.
Esophagoscopy (direct visual inspection of the inside of the esophagus) is a very helpful tool in diagnosing certain diseases that can cause regurgitation. Examples include esophagitis, foreign body and growths. This procedure necessitates anesthesia and is associated with more risk than some of the previously mentioned diagnostics. Most often a specialist is involved as experience and special instrumentation is needed.
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