How Doctors Diagnose Esophageal Disorders

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Because many medical conditions share the common symptoms of esophagitis—swallowing pain or difficulty, heartburn, and chest discomfort—your doctor will perform several tests before arriving at a diagnosis of reflux esophagitis or another type of esophageal inflammation. Many of these tests involve looking at esophageal tissue directly or through imaging tests. Your doctor may also have a pathologist look at esophageal cells under a microscope. Understanding the nature of these diagnostic tests may help ease any concerns you have about the process of diagnosing esophagitis.

Barium X-ray (Swallow)

A barium X-ray (also called a barium swallow or upper GI series) is an imaging test that allows your doctor to view how your throat, esophagus and stomach function together. During a barium X-ray, you will be asked to drink a solution that contains barium, a chemical substance that coats the internal surfaces of anatomical structures and makes them easier to see on images. As you drink it (or after you finish it), you may be asked to stand, sit or bend in front of an X-ray machine that captures images. The images show how the barium moves from your throat, through the esophagus, and into the stomach.

A barium X-ray can help your doctor identify strictures (narrowing) of the esophagus or other abnormalities that may be causing your esophagitis symptoms. Drinking barium is not too unpleasant and will not cause you any harm. Later, the barium will pass out of your system through stool.

There are variations of barium X-ray tests that focus more on the chewing and swallowing process. For these tests, the patient consumes barium of varying consistency, like thin barium liquids, barium shakes, and barium cookies.


This common procedure allows your doctor to directly examine your esophagus, stomach and other structures. During endoscopy (upper GI endoscopy), the doctor will give you medications to lightly sedate you before inserting a thin, flexible scope into your esophagus. The scope holds a tiny camera that produces images on a nearby monitor, giving your doctor an up-close look at any areas of esophageal inflammation, erosions, diverticula (tiny sacs that form in the walls of the esophagus) and other types of disease or damage.

The endoscopic examination allows your doctor to identify potentially cancerous growths or a damaged sphincter (valve) at the top of the stomach.

Esophagus Biopsy

During an endoscopy, your doctor can remove small tissue samples for microscopic examination. A pathologist will look at the samples under a microscope to determine if they contain malignant (cancerous) cells, high concentrations of eosinophils (white blood cells that can accumulate in esophageal tissue, causing eosinophilic esophagitis), or other abnormalities. The pathologist also can diagnose an infection due to bacteria, viruses or fungi as a possible cause of your symptoms.

Esophageal Manometry

This test assesses the function of your esophagus by measuring how powerful the structure’s muscle contractions are when you swallow. Your doctor inserts a thin tube into your nose and down into your stomach. You swallow multiple times while the doctor gently pulls the tube back up from your stomach through your esophagus. The tube will measure muscle contractions all along the esophagus as you swallow, which helps your doctor determine if your esophagus is moving food efficiently from the mouth to the stomach.

Most people tolerate esophagitis testing very well, with little to no discomfort. These tests provide important information for your doctor to diagnose reflux esophagitis or another form of esophageal inflammation. Receiving an accurate diagnosis leads to earlier treatment that can spare you from developing permanent esophageal tissue damage that requires surgery to repair.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Sep 19
  1. Esophagitis. U.S. National Library of Medicine, MedlinePlus.
  2. Eosinophilic Esophagitis. U.S. National Library of Medicine, Medline Plus.
  3. Esophagitis – Infectious. U.S. National Library of Medicine, MedlinePlus.
  4. Gastroesophageal Reflux Disease. U.S. National Library of Medicine, MedlinePlus.
  5. Esophagitis. Mayo Clinic.
  6. Upper GI and Small Bowel Series. U.S. National Library of Medicine, MedlinePlus.
  7. Understanding Esophageal Manometry. American Society for Gastrointestinal Endoscopy.

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