Decreased tone of the lower esophageal sphincter is one of the symptoms of scleroderma esophagus, a connective tissue disease that affects the fibrous tissue and small blood vessels of several organs. When the esophagus is involved, it leads to spasm and ischemia of the esophageal smooth muscle, as well as atrophy of the smooth muscle and the formation of submucosal collagen deposits and fibrosis. How to diagnose decreased lower esophageal sphincter tone? 1. The esophagus shows delayed emptying, difficulty in swallowing or reflux symptoms. 2.Esophageal manometry shows triple low phenomenon. 3. 24h esophageal pH monitoring confirms pathological reflux. 4.Endoscopic examination confirms the presence of esophagitis and excludes other esophageal diseases. Esophageal tuberculosis: Patients with esophageal tuberculosis usually have most of the precursor 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. 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 scar stenosis due to fibrosis of the lesion. Fungal esophagitis: The clinical symptoms of fungal esophagitis are atypical. Some patients can be without any clinical symptoms. Common symptoms are painful swallowing, 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. In granulocytopenic patients with persistent hyperthermia, the skin, liver, spleen and lungs should be examined for disseminated acute candidiasis.