Esophageal Disorders

Esophageal disorders are a collection of conditions that affect how the esophagus works. Your esophagus or the food pipe is the part of the digestive system that helps food travel from your mouth to your stomach.
Different diseases can affect the esophagus, causing dysphagia or difficulty swallowing. The most common esophageal disorder is gastrointestinal reflux disease (GERD). GERD is the condition in which excessive stomach acid moves back into the esophagus (acid reflux), causing inflammation.

What are the types of esophageal disorders?

Types of esophageal disorders include:

• GERD: The most common esophageal disorder occurs when the lower esophageal sphincter doesn’t close properly. As a result, stomach acid and contents flow backward into your esophagus.
• Achalasia: The lower esophageal sphincter doesn’t open or relax, preventing food from going into the stomach. Experts believe achalasia may be an autoimmune disease, but the exact cause is unknown. Something damages the nerves that control the muscles in the esophagus.
• Barrett’s esophagus: For people with chronic, untreated acid reflux, the lining of the bottom part of their esophagus starts looking like stomach lining, and the cells start to resemble intestinal cells. These changes take place where the esophagus and stomach meet. This condition is associated with a higher risk of esophageal cancer.
• Eosinophilic esophagitis: White blood cells called eosinophils become overabundant in the esophagus. The result is inflammation or swelling of the esophageal lining (esophagitis). This condition is more common in patients with multiple allergies.
• Esophageal cancer: There are two types of esophageal cancer: squamous cell carcinoma, and adenocarcinoma. Generally speaking, smoking, radiation and HPV infection increases the risk of esophageal squamous cell carcinoma, while smoking and acid reflux increase risks of adenocarcinoma.
• Esophageal diverticulum: An outpouching occurs in a weak spot in the esophagus. People with achalasia are more prone to developing diverticula.
• Esophageal spasms: Abnormal muscle spasms (contractions) occur in the esophagus. This rare, painful condition keeps food from reaching the stomach.
• Esophageal strictures: The esophagus becomes too narrow. Foods and liquids pass through slowly to the stomach.
• Hiatal hernias: The upper part of the stomach protrudes above an opening in the diaphragm, and sits in the chest. This condition leads to more acid reflux.

SYMPTOMS AND CAUSES

What are the risk factors for esophageal disorders?

Factors that increase the chances of developing an esophageal disorder include:

• Alcohol use.
• Extra weight due to obesity or pregnancy.
• Medications, including certain antibiotics, antidepressants and pain relievers.
• Radiation therapy to your neck or chest.
• Smoking, including exposure to secondhand smoke.

What are the symptoms of esophageal disorders?

Symptoms vary depending on the type of esophageal disorder. You may experience:

• Abdominal pain, chest pain or back pain.
• Chronic cough or sore throat.
• Difficulty swallowing or feeling like food is stuck in your throat.
• Heartburn (burning feeling in your chest).
• Hoarseness or wheezing.
• Indigestion (burning feeling in your stomach).
• Regurgitation (stomach acid or contents coming back up your esophagus to your mouth) or vomiting.
• Unexplained weight loss.

DIAGNOSIS AND TESTS

How are esophageal disorders diagnosed?

Your healthcare provider will evaluate your symptoms and perform a physical exam. They may feel your neck while you swallow.

Diagnostic tests for esophageal disorders include:

• Upper endoscopy examines the upper part of the digestive tract using a long, thin scope. Your provider may also take tissue samples to biopsy and look for signs of inflammation, cancer and other diseases.
• Gastrointestinal X-rays (barium swallow) use imaging to see how a liquid barium solution flows through the esophagus and digestive tract.
• Esophageal manometry measures how well the muscles in your esophagus and lower esophageal sphincter work as you swallow a liquid.
• Esophageal pH test measures the amount of stomach acid (pH levels) in your esophagus.

How are esophageal disorders treated?

Treatments vary depending on the condition. They may include:

• Antacids, proton pump inhibitors and histamine receptor (H2) blockers to reduce stomach acid.
• Endoscopic dilation to open a narrowed esophagus or relax a sphincter muscle.
• Botulinum toxin (Botox®) injections to temporarily stop esophageal spasms or relax the sphincter muscle.
• Esophagectomy surgery to remove part or all of a diseased esophagus.
• Laparoscopic antireflux surgery (Nissen fundoplication) to treat GERD or a hiatal hernia by reinforcing the lower esophageal sphincter.
• Heller myotomy and peroral endoscopic myotomy (POEM) treat achalasia and esophageal spasms.