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Esophagus Conditions

Gastroesophageal Reflux Disease (GERD)

When stomach contents travel back up your esophagus, this is called GERD. Your esophagus is a tube which connects the mouth to the stomach. At the lower end of the esophagus there is a muscular ring called the lower esophageal sphincter (LES). The LES should remain tightly closed except to allow food to pass normally into the stomach. Inappropriate relaxation of the LES allows stomach contents, including acid, to flow back into the esophagus. This creates typical symptoms of GERD such as heartburn and regurgitation. More atypical symptoms such as chest pain, cough, sore throat and laryngitis may also occur. Certain lifestyle choices and foods can exacerbate reflux symptoms. These include spicy foods, acidic foods, chocolate, peppermint, caffeine, alcoholic beverages, tobacco products, overeating, and obesity. Chronic reflux can cause complications such as esophageal ulceration, bleeding, stricture (narrowing of the esophagus) formation, and a precancerous condition called Barrett's esophagus. GERD can usually be diagnosed on the basis of a patient's symptoms. Treatment is aimed at reducing reflux of acidic gastric material, and can most often be achieved through lifestyle modification, dietary changes, and medications to neutralize or inhibit the production of stomach acid.

Difficulty Swallowing (Dysphagia)

When you feel that food is not passing appropriately from the mouth through the esophagus into the stomach, this is called Dysphagia, known as difficulty swallowing. This occurs when food or liquids do not pass out of the mouth into the beginning of the esophagus, often resulting in coughing, choking or a feeling of things going down the wrong pipe. This is most likely to occur with nerve or muscle disorders such as a stroke or Parkinson's disease. These symptoms can best evaluated and treated with the assistance of a speech pathologist using X-rays to evaluate the swallowing process. This problem may arise from a narrowing of the esophagus (stricture), inflammation of the lining of the esophagus, or abnormal motor function of the muscles in the wall of the esophagus. Dysphagia resulting from an esophageal stricture will typically respond to stretching or dilatation of the narrowed esophageal segment.

Barrett's Esophagus

Barrett’s is a pre-cancerous condition affecting the lining of the esophagus, the tube that carries food from the mouth into the stomach. This condition usually starts with GERD (listed above). When left untreated over time, this causes injury to the esophageal lining. It causes inflammation and genetic changes that cause the cells to take on a different appearance, hence being diagnosed as this disease. Barrett's esophagus increases the risk for a patient to develop esophageal cancer. Patients with Barrett's esophagus should have periodic endoscopic evaluation with biopsies looking for a condition called dysplasia, which places them at even higher risk for the development of esophageal cancer.

Esophagitis

Inflammation of the lining of the esophagus, the tube that carries food from the mouth to the stomach. It is most commonly caused by stomach contents, including acid, traveling back up into the esophagus, a condition known as gastroesophageal reflux disease (GERD). Esophagitis can also be caused by infection with viruses or yeast, medications or radiation therapy. Symptoms of esophagitis may include heartburn, pain with swallowing or difficulty swallowing (dysphagia). Diagnosis it typically made by passing a flexible tube through the mouth into the esophagus to directly visual the lining of the esophagus (endoscopy).

Esophageal Stricture

When longstanding irritation of the esophageal lining happens from reflux of stomach acid, your esophagus can narrow. We call this narrowing, esophageal stricture. Strictures may also be caused by cancer, radiation therapy or the ingestion of caustic liquids such as lye. Liquids will pass easily but larger pieces of solid food will cause difficulty passing through the narrowed segment of the esophagus. Esophageal strictures will typically respond to stretching or dilatation of the narrowed esophageal segment during an endoscopy.

Schatzki's Ring

Schatzki’s Ring is a thin fibrous ring of tissue at the lower end of the esophagus. When narrowed, it will partially obstruct the esophagus just before it empties into the stomach. Sometimes when swallowing, large pieces of food will lodge in the lower esophagus, but eventually pass into the stomach. The symptoms caused by a Schatzki's ring will typically respond to stretching or dilatation of the ring during endoscopy.

Esophageal Varices

Enlarged veins that arise in the lower esophagus in patients due to uncommon liver conditions such as cirrhosis is called esophageal varicies. They resemble varicose veins of the legs. Blood from the gastrointestinal tract normally flows through the liver. Scarring of the liver from cirrhosis prohibits normal blood flow and increases the pressure in the blood vessels. The veins swell producing varices. Severe bleeding can occur if the varices rupture. All patients with cirrhosis of the liver should undergo periodic endoscopy to look for varices. If they are present, medica-tion can be used to lower the blood pressure within the varices to decrease the risk of bleeding.

Esophageal Motility Disorders

This is a diseases caused by abnormal esophageal muscle function. The muscles in the wall of the esophagus contract and relax in an organized fashion to propel food from the mouth into the stomach. Abnormal muscle func-tion can cause difficulty swallowing and sometimes even chest pain. This disorder can be brought on by an allergic reaction to certain foods and by autoimmune disease affecting the muscles of the esophagus.

Esophageal Cancer

This type of cancer is an abnormal growth or tumor which originates from the lining of the esophagus. Patients with esophageal cancer often complain of difficulty swallowing because the cancerous growth partially blocks the esophageal opening. Risk factors for esophageal cancer include tobacco use, alcohol consumption, and chronic gastroesophageal reflux disease. Treatment options include surgery, chemotherapy, radiation therapy, and stent placement to relieve obstruction.

Eosinophilic Esophagitis

This is an inflammatory condition in the esophagus which causes difficulty swallowing. Patients often complain of food sticking in the esophagus and may at times require an emergency procedure to remove a piece of food lodged in the esophagus. Eosinophilic esophagitis is likely caused by an allergic reaction to certain foods or other environmental agents. Treatment consists of avoiding these inciting factors or using medications such as steroids.