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Esophageal

The esophagus is a muscular tube through which food, liquids and saliva passes from the mouth to the stomach. It is lined with a soft-moist tissue called, mucosa. The esophagus has two sphincters, the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES). The upper esophageal sphincter (UES) is a region of muscle located at the top of the esophagus. It prevents the food and secretions from going down the wind pipe. These UES muscles are under conscious control and are involved in breathing, eating, belching, and vomiting. Another bundle of muscles called lower esophageal sphincter (LES), is located at the lower end of the esophagus, just where it joins the stomach. As food enters the esophagus, the LES relaxes and allows the food to pass in to the stomach. The LES muscles are not under voluntary control.

Disorders affecting the esophagus include:

  • Heartburn: Heartburn is characterized by a burning type pain in the lower part mid-chest, behind the breast bone. It is caused by irritation of the esophagus due to the reflux of acidic stomach contents into the esophagus. The reflux occurs due to the incomplete closure of LES.
  • Gastroesophageal reflux disease (GERD): Gastro-esophageal reflux disease is a condition where the stomach contents (food or liquid) rise up from the stomach into the esophagus because of a weak or relaxed lower esophageal sphincter (LES). Heartburn is usually the main symptom. Other symptoms include belching, chronic sore throat, difficulty or pain when swallowing, sudden excess of saliva, hoarseness, sour taste in the mouth, inflammation of the gums, bad breath and erosion of tooth enamel.
  • Esophagitis: Esophagitis is an inflammation of the esophagus caused by irritation (as from reflux) or an infection.
  • Barrett’s esophagus: Barrett’s esophagus is a condition in which the lining of the esophagus changes and resembles the stomach lining The cause for the Barrett’s esophagus is not known but is commonly found in people with gastro-esophageal reflux disease (GERD Barrett’s esophagus increases the risk for esophageal cancer.
  • Esophageal ulcer: It is erosion in the lining of the esophagus often caused by chronic reflux.
  • Esophageal stricture: Esophageal stricture is narrowing of the esophagus often caused by chronic reflux.
  • Achalasia: It is a rare disorder characterized by difficulty in swallowing and regurgitation of food. In this condition, the LES does not relax appropriately.
  • Esophageal cancer: It is a cancer that occurs in the esophagus. It is rare and factors such as smoking, heavy drinking and chronic reflux increase the risk of developing esophageal cancer.
  • Mallory-Weiss tear: It is a tear in the lining of the esophagus. It is usually caused by forceful vomiting or chronic coughing. Symptoms may include bloody stools or vomiting of blood.
  • Esophageal varices: Esophageal varices are enlarged veins in the walls of the esophagus that balloon outward. This condition is common in people with cirrhosis of liver. Rupture of these veins may lead to life threatening bleeding.
  • Esophageal ring (Schatzki’s ring): It is an abnormal ring of tissue formed around the low end of the esophagus. It is a birth defect of the esophagus. Usually it does not cause any symptoms but in some it may cause difficulty in swallowing and the food feels stuck in the lower neck.
  • Esophageal web: These are small, thin growths of tissue that partially block the esophagus. They usually occur in the upper esophagus and cause no symptoms. In people with long-term (chronic) iron deficiency anemia, esophageal web may lead to difficulty in swallowing. This condition is referred as Plummer-Vinson syndrome.

Tests to diagnose these disorders may include upper endoscopy, esophageal pH monitoring and barium swallow.

Treatment varies according to the type of disorder. Medications such as H2 blockers and proton pump inhibitors are prescribed to reduce stomach acid to improve GERD and esophagitis. Surgical removal of the esophagus (Esophagectomy) is recommended for esophageal cancer. Esophageal dilation may be advised to dilate a stricture, web, or ring that interferes with swallowing. Esophageal variceal banding may be used to treat esophageal varices. In this procedure, rubber band-like devices are wrapped around esophageal varices to make them clot, and thus reduce the chances of life threatening bleeding.