General Esophagus Conditions

Your esophagus is a crucial part of your gastrointestinal tract and the process of digestion. Commonly called the food pipe, it is an eight-inch long, muscular tube that serves as a conduit between your throat (pharynx) and your stomach. Your awareness of your esophagus probably ends when you swallow, as it seamlessly coordinates your food’s journey to your stomach.

When this tube becomes impaired, this process is disrupted and requires medical intervention. This treatment can be as simple as taking medication, or as intensive as having an operation.

How Does the Esophagus Work?

The esophagus is composed of strong muscles that gradually push and squeeze food into your stomach in a downward rhythm (peristalsis). Glands in the food pipe’s lining generate mucus, which moistens the tube and eases the process of swallowing.

The food pipe is bookended by tightly closed muscles called sphincters. The upper sphincter relaxes when it senses that you’re swallowing, and the lower sphincter opens when food reaches the stomach. When you’re not eating, both sphincters tighten, so food and stomach acid don’t back up into the esophagus.

What Are Some Conditions of the Food Pipe?

These are several of the conditions, their symptoms, and their treatment.

Achalasia

Achalasia (meaning “failure to relax”) is a rare swallowing disorder. It occurs when the sphincter between the food pipe and the stomach malfunctions. Usually, when you swallow, this signals the sphincter to relax so that food and liquids can flow into your stomach. However, achalasia prevents this sphincter from loosening, causing food to become lodged in the food pipe.

The condition is caused by damaged esophagus nerves. Over time, the food pipe becomes paralyzed and dilated as the nerves break down and vanish This impairs the food pipe’s ability to push food into the stomach.

Symptoms of achalasia include:

• Vomiting food.
• Trouble swallowing.
• Heartburn.
• Weight loss.
• Intermittent chest pain.
• Stomach contents may be regurgitated into the lungs, leading to pneumonia, heart infections, or death.

Although achalasia can’t be cured, there are surgical and non-surgical treatments for the condition that address decreasing the lower esophageal sphincter’s tautness. These include:

• Pneumatic Dilation: During pneumatic dilation, a balloon is placed in the esophageal sphincter and inflated to enlarge it. This procedure may need to be redone if the sphincter closes again.
• Heller Myotomy: In Heller myotomy, your surgeon cuts the esophageal sphincter so that food and fluid can pass more easily into your stomach.
• Peroral Endoscopic Myotomy (POEM): This procedure involves the insertion of an endoscope down your throat to make several incisions in the bottom of your food pipe. This process relaxes and widens the taut esophagus muscles, enabling food and fluids to travel smoothly from your esophagus into your stomach.
• Medication: Your doctor may order medication to counter the symptoms of achalasia. Two types of drugs are typically prescribed: calcium channel blockers and nitrates, which relax your sphincter’s muscles.

Barrett’s Esophagus

Barrett’s esophagus is a complication of gastroesophageal reflux disease (GERD), a condition in which stomach acid backwashes into your esophagus. Barrett’s is characterized by the esophagus’ normal tissue changing to tissue similar to the small intestine’s lining. These tissue changes may occur because the acid aggravates the food pipe’s lining.

Symptoms of Barrett’s include:

• Heartburn that happens at least twice a week.
• Bloody stools.
• Feeling as though food is stuck in your throat.
• Bitter taste in your mouth.
• Difficulty swallowing.
• Unexplained weight loss.

When it comes to treatment, your doctor may prescribe proton pump inhibitors, which are medications that can ease your symptoms, prevent further damage or heal the food pipe’s lining. These include medications that are available by prescription, as well as over-the-counter (OTC):

• Prilosec (OTC).
• Prevacid (OTC).
• Nexium (prescription).
• Protonix (prescription).

If these treatments are unsuccessful, surgery may be necessary:

• Cryoblation: During cryoblation, the abnormal Barrett’s cells are frozen with carbon dioxide gas or liquid nitrogen to injure them. Liquid nitrogen is 320 degrees below zero (Fahrenheit) and instantly freezes anything it touches.
• Nissen Fundoplication: Nissen fundoplication involves wrapping the top of your stomach around the lower esophagus. This boosts the anti-reflux function and may yield lasting relief.
• Radiofrequency Ablation: An endoscope is inserted into the food pipe, producing radio waves that destroy abnormal cells, while sparing the normal ones.
• Photodynamic Therapy: Prior to this procedure, you’ll swallow a drug called Photophrin, which illuminates abnormal cells, so they can be easily seen and eradicated.

Esophageal Stricture

An esophageal stricture is an abnormal narrowing and tightening of the food pipe. This is caused by stomach acid that progressively inflames the esophagus, creating layers of scar tissue that cause it to narrow. Esophageal strictures are typically caused by GERD:
Symptoms of an esophageal stricture include:

• Feeling as though food is stuck in your throat.
• Heartburn.
• Gagging or coughing when swallowing.
• Stomach acid or food that backwashes into your throat.
• Regurgitation.
• Unintentional weight loss.

Treatments:

• Esophageal Dilation: Esophageal dilation is a procedure that stretches the esophagus. During dilation, your doctor will pass an endoscope through your food pipe, stomach, and small intestine. Once they locate the scarred, narrow area, they’ll insert a dilator (a tube with a balloon at one end) into the esophagus. As the balloon inflates, it widens the narrow section of the food pipe.
• Esophageal Stent: An esophageal stent is a tube made of plastic, silicone, or metal mesh that is placed in the blocked area of the esophagus. The stent expands against the walls of the food pipe to keep them open while you eat or drink.
  Medication: Medications called proton pump inhibitors block acids so that the stricture doesn’t return.

Esophageal Webs

Esophageal webs are thin membranes that spread across the upper portion of your esophagus. They can block it partially or completely. People who have webs often suffer from reflux issues or iron deficiency anemia, as well.

Symptoms:

• Sore tongue.
• Cracks around the corners of your mouth.
• Feeling as though something is stuck in your chest.
• Weight loss.
• Difficulty swallowing.

Treatment:

• A common treatment for this condition involves widening your throat, so the web doesn’t block it. It can be stretched with a balloon inserted with an endoscope or with a dilator.
• Webs can be permanently stretched with an instrument that goes through an endoscope and severs them.

Esophageal Diverticulum

An esophageal diverticulum is a bulge in a weak part of the food pipe’s lining. There are three types of diverticula:

• Zenker’s diverticulum, located in the back of the throat.
• Midthoracic diverticulum, located mid-chest.
• Epiphrenic diverticulum, located above the diaphragm.

Symptoms:

• Pain when swallowing.
• Dysphagia (trouble swallowing).
• Pulmonary aspiration (foreign matter inhaled into the lungs).
• Aspiration pneumonia (lung infection caused by pulmonary aspiration).
• Weight loss.

The type of surgery used depends upon the size and location of the diverticulum.

• Cricopharyngeal Myotomy: Cricopharyngeal myotomy is used for small diverticulum. It encompasses cutting a food pipe muscle to make swallowing easier.
• Diverticulopexy with Cricopharyngeal Myotomy: This procedure is used for larger diverticulum. The pouch is attached to the food pipe’s wall, rather than being removed.
• Diverticulectomy and Cricopharyngeal Myotomy: Diverticulectomy and Cricopharyngeal Myotomy involves completely removing the diverticulum.

Dysphagia

Dysphagia is a disorder that makes swallowing liquids or solid food difficult, painful or impossible. Some people even choke on their own saliva. Others avoid eating or drinking because they’re afraid they’ll choke, resulting in weight loss, malnutrition, and dehydration.

Symptoms:

• Regurgitating food or bringing it up through the nose.
• Choking when drinking or eating.
• Coughing when swallowing.
• Feeling as though food is stuck in your throat.
• Inability to properly chew food.
• Difficulty breathing.
• Weight loss.
• Aspiration pneumonia (a condition that occurs when you breathe food or liquid into your lungs).

Treatments:

• Swallowing Therapy: Swallowing therapy is conducted by a speech-language therapist, who will guide you through exercises that will strengthen your tongue, jaw, and swallowing muscles so that you can swallow effectively.
• Surgery: When dysphagia is related to an obstruction, such as a tumor, it can be surgically removed. If your dysphagia is related to a narrowed esophagus, a stent can be used to widen it.
• Botulinum Toxin (Botox): If the muscles in your throat have stiffened, botulinum can paralyze them, which eases the tightness and makes swallowing easier.
• Liquid Diet: If you have trouble swallowing, a liquid diet can help you keep weight on and reduce dehydration.
• Feeding Tube: In cases of severe dysphagia, a feeding tube can circumvent the malfunctioning part of your chewing structure. These tubes can either go through your nose and into your stomach or be implanted in your stomach.

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