Oesophagitis dissecans superficialis is an extremely rare and benign condition where the mucosal epithelium of the oesophagus sloughs off along the whole length of the oesophagus and is expelled as an oesophageal cast. This condition has been reported in association with various aetiological factors. We report a case of an oesophageal cast in a patient who underwent repeated oesophagoscopy and dilatation for a postcricoid web. We discuss the possible relationship between trauma to the upper oesophagus and the development of oesophagitis dissecans superficialis.

This study assessed the ability of otolaryngologists to diagnose and grade reflux disease at rigid endoscopy. Twenty-one out of 25 senior otolaryngologists who were questioned by means of a telephone survey said that if they find evidence of reflux disease at rigid endoscopy of the oesophagus and larynx, their practice is to place the patient on a proton pump inhibitor for six weeks without requesting pH and manometry studies, and without referral to a gastroenterologist. Over a two year period, 21 patients were diagnosed as having reflux disease at rigid endoscopy. This was based on the finding of fluid and erythema in the aerodigestive tract and upper oesophagus. Subsequent oesophageal pH and manometry was performed. Nine out of 21 patients were confirmed as refluxers. This demonstrated an accuracy of less than 50 per cent when using these findings to diagnose gastro-oesophageal reflux at rigid endoscopy.

The extraction of impacted foreign bodies from the oesophagus is frequently performed using forceps under endoscopic guidance. We report the case of a 23-year-old prisoner who ingested a lump of cannabis resin which could not be removed from the upper oesophagus with forceps alone. We recommend the use of a Fogarty balloon catheter in conjunction with toothed forceps in such cases.

Flexible endoscopy of the upper gastrointestinal tract usually does not form part of the primary diagnostic evaluation of the globus syndrome. In a prospective trial, a flexible endoscopy was performed in 51 globus patients with normal results of the laryngologic and radiographic examination. Pathologic findings requiring therapy were diagnosed in 70.6 per cent of cases. The most frequent findings were reflux oesophagitis (n = 24; 47 per cent) and hiatial hernia (n = 25; 49 per cent). In 16 cases (31,4 per cent) these were accompanied by other pathologic lesions. A total of 32 patients (62.7 per cent) suffered from oesophageal diseases as sole aetiologic factors of the globus syndrome, which led us to postulate a causative relationship in these cases. Flexible endoscopy therefore can contribute significantly to the differential diagnosis of the globus syndrome. It must be kept in mind, however, that there is a ‘blind zone’ for endoscopic assessment in a region of the hypopharynx, thus some indications may require rigid endoscopy.