What conditions should be differentially diagnosed with decreased lower esophageal sphincter tone? 1. Esophageal tuberculosis: Patients with esophageal tuberculosis usually have the first symptoms of tuberculosis in other organs, especially pulmonary tuberculosis. The symptoms of esophagus itself are often confused or masked by the symptoms of other organs, so that they cannot be detected in time. In accordance with the pathological process of tuberculosis, the early infiltrative progressive stage can have toxic symptoms such as malaise, low fever, and increased blood sedimentation, but there are also those with no obvious symptoms. This is followed by dysphagia and progressive dysphagia, often accompanied by persistent pain in the pharynx and retrosternal area, which is aggravated when swallowing. The formation of tracheoesophageal fistula should be considered for food spillage into the trachea. Difficulty in swallowing suggests lesion fibrosis causing scar stenosis. 2, fungal esophagitis: the clinical symptoms of fungal esophagitis are mostly atypical. Some patients may not have any clinical symptoms. Common symptoms are swallowing pain, dysphagia, epigastric discomfort, retrosternal pain and burning sensation. In severe cases, the retrosternal pain is knife-like and may radiate to the back, resembling angina pectoris. Severe bleeding can occur in Candida esophagitis, but is uncommon. Untreated patients may have epithelial detachment and perforation, even disseminated. Candidiasis esophageal perforation can cause mediastinitis esophagotracheal fistula and esophageal stricture. For granulocytopenic patients with persistent hyperthermia, the skin, liver, spleen and lungs should be examined for disseminated acute candidiasis. 3, viral esophagitis: HSV infection of the esophagus is often accompanied by nasolabial herpes. The main symptom is painful swallowing, and the pain often increases when swallowing food. After the patient swallows, the food goes down slowly in the esophagus, and a few patients have difficulty swallowing as the main symptom. Mild infections may be asymptomatic.