Discriminate value of esophageal symptoms: a study of the initial clinical findings in 499 patients with dysphagia of various causes.

The aim of this study was to determine whether the characteristics of esophageal symptoms may be of diagnostic utility in distinguishing dysphagia of various causes. Included in the study were a total of 499 patients with three types of dysphagia: 234 with dysphagia related to an obstructive lesion in the esophagus, 162 with dysphagia related to disturbed esophageal motility, and 103 with dysphagia who had no demonstrable structural or motor abnormalities in the esophagus. In the first part of the study, the initial esophageal symptoms of 402 patients with dysphagia were retrospectively reviewed and analyzed with use of a stepwise logistic regression. This analysis led to development of models that could distinguish among the various diagnostic groups of dysphagia. In the second segment of the study, these models were validated in a prospective assessment that involved 97 patients with dysphagia. In the third part of the study, the models were further refined by using data from all 499 patients from the first two parts. The results presented herein suggest that a subset of selected esophageal symptoms can distinguish among diagnostically identified groups of dysphagia. The discriminate models presented rely on a few easily determined clinical variables and hence are practical and potentially useful in the evaluation of undifferentiated dysphagia.