Benign Esophageal Diseases
About the Esophagus
The esophagus is a hollow, muscular, tube-shaped organ. It provides the route for food, fluid, and saliva to pass from your mouth to your stomach. The esophagus extends from the back of the throat to the stomach, passing through the neck, chest, and abdomen. It is described as having upper (cervical), middle (thoracic) and lower (abdominal) portions and is lined with a mucous membrane, similar to the lining of the mouth. Wave-like contractions of the walls of the esophagus push food and liquid downward through the esophagus and into the stomach.
Two circular bands of muscle, called sphincters, keep the upper and lower ends of the esophagus closed except during swallowing, belching or vomiting. The upper esophageal sphincter prevents air from entering the esophagus and prevents fluids and food in the esophagus from going into the airway. The lower esophageal sphincter prevents stomach contents from reentering the esophagus.
What is Gastroesophageal Reflux Disease (GERD)?
Gastroesophageal reflux disease (GERD) is present when the lower esophageal sphincter does not function properly and continued reflux of stomach contents into the lower esophagus causes heartburn or injury to the esophagus. Persistent reflux of stomach contents into the esophagus eventually produces tissue ulceration and can lead to bleeding, perforation, or stricture formation. Most patients develop chronic, recurrent esophagitis. GERD is the most common functional abnormality of the esophagus that may require surgical treatment.
What is Barrett’s Esophagus?
In some patients with GERD, the normal squamous cell lining of the lower esophagus is destroyed and replaced with abnormal tissue. This condition is known as Barrett’s esophagus. Patients with Barrett’s esophagus may develop more changes in the esophagus, called dysplasia (abnormal development). Where dysplasia occurs, the risk of esophageal cancer increases. Barrett’s esophagus occurs more often in men than women, and a patient is likelier to have this condition of they have had GERD for a long time.
What lifestyle changes can reduce GERD symptoms?
- Avoid dietary fat, chocolate, caffeine, and peppermint, which can cause lower esophageal pressure and allow stomach acid to flow backward
- Avoid alcohol and tobacco
- Avoid lying down after meals
- Lose weight
- Sleep with the head of the bed elevated
- Take all medications with plenty of water
What medications can relieve symptoms of GERD?
- Proton pump inhibitors
- Antacids after meals and at bedtime
- Histamine H2 receptor blockers
- Promotility agents
What medications can make GERD worse?
- Anticholinergics (anti-motion sickness medicines)
- Bronchodilators for asthma
- Calcium channel blockers for high blood pressure
- Dopamine-active drugs for Parkinson’s disease
- Tricyclic antidepressants
If you suspect that one of your medications may be causing heartburn, contact your physician. Never change or stop a medication you take regularly without first consulting your physician.
What are the treatment options for GERD and Barrett’s Esophagus?
Aggressive medical therapy and even endoscopic ablation are used to control GERD and Barrett’s esophagus. When these treatments are not successful, we offer minimally invasive surgery to prevent continued reflux and esophageal damage. In patients with severely abnormal or pre-cancerous changes in the esophagus, esophagectomy (removal of most of the esophagus and replacement with stomach) may be recommended. Most often, this can be achieved using a minimally invasive approach.
What is Esophageal Motility Disorder?
Esophageal motility disorder is a condition in which esophageal contractions are abnormal, one of the sphincters (at the top and bottom of the esophagus) does not function properly, or both. A motility disorder may affect the upper or lower esophageal sphincter, or the body of the esophagus.
What is Achalasia?
Achalasia is a degenerative neural abnormality, it is characterized by absent peristalsis in the body of the esophagus and incomplete or absent relaxation of the lower esophageal sphincter in response to swallowing.
What is Dysphagia?
Dysphagia is a term used to describe swallowing disorders. Swallowing involves muscles from the mouth, throat, and esophagus, and is controlled by many nerves. While part of the act of swallowing is voluntary, much of the action is controlled by involuntary muscles. Problems in any part of the esophagus can result in difficulty swallowing.
Chest pain, the feeling of food stuck in the throat, or heaviness or pressure in the neck or upper or lower chest when eating are frequently the result of swallowing difficulties.
Causes of Dysphagia
There are many different causes of dysphagia, including a blockage due to:
- Cervical spine disease
- Emotion or anxiety disorder
- Esophageal webs
- Narrowings (strictures) in the esophagus due to radiation, chemicals, medications, chronic inflammation, or ulcers
- Schatzki’s ring
- Zenker’s diverticulum
Treatments for Dysphagia
Before a treatment for dysphagia can be administered, a proper diagnosis should be made. If you feel symptoms of dysphagia, you should contact your doctor.