Mixed Esophageal Disease (MED): A New Concept

We define mixed esophageal disease (MED) as a disorder of esophageal structure and/or function that produces variable signs or symptoms, simulating-fully or in part other well-defined esophageal conditions, such as gastroesophageal reflux disease, esophageal motility disorders, or even neoplasia. The central premise of the MED concept is that of an overlap syndrome that incorporates selected clinical, endoscopic, imaging, and functional features that alter the patient's quality of life and affect natural history, prognosis, and management. In this article, we highlight MED scenarios frequently encountered in medico-surgical practices worldwide, posing new diagnostic and therapeutic challenges. These, in turn, emphasize the need for better understanding and management, aiming towards improved outcomes and prognosis. Since MED has variable and sometimes time-evolving clinical phenotypes, it deserves proper recognition, definition, and collaborative, multidisciplinary approach, be it pharmacologic, endoscopic, or surgical, to optimize therapeutic outcomes, while minimizing iatrogenic complications. In this regard, it is best to define MED early in the process, preferably by teams of clinicians with expertise in managing esophageal diseases. MED is complex enough that is increasingly becoming the subject of virtual, multi-disciplinary, multi-institutional meetings.

Automated summary

Mixed esophageal disease (MED) is a disorder that affects the structure and/or function of the esophagus, presenting symptoms and signs that resemble or partially resemble other well-defined esophageal conditions. The MED concept emphasizes the overlap syndrome, incorporating various clinical, endoscopic, imaging, and functional features that have an impact on the patient's quality of life, prognosis, and management. This article focuses on frequently encountered MED scenarios in medico-surgical practices worldwide, highlighting the need for better understanding and management to improve outcomes and prognosis. Proper recognition, definition, and a collaborative, multidisciplinary approach are crucial in optimizing therapeutic outcomes while minimizing complications.