What Is Esophagus?
The esophagus is the hollow, muscular tube that connects the throat to the stomach. It is a component of the digestive system. The primary function of the esophagus is to transport food and liquid from the mouth to the stomach. Food and liquid pass down from the mouth to the throat when swallowed (pharynx). An epiglottis, a small muscular flap, helps to prevent food and liquid from passing down the windpipe by closing it.
Acid reflux is the most common problem that can affect the esophagus. Acid reflux happens when the lower esophageal sphincter opens when it should not. This allows stomach acid and digestive juices to flow back into the esophagus from the stomach. This may result in inflammation and heartburn.
The underlying cause determines treatment for esophageal problems. Over-the-counter medications and dietary changes can help with some esophageal problems. However, other conditions may necessitate the use of prescription medications, procedures, or surgery.
The muscles at the top and bottom of the esophagus are crucial to the process. If the lower muscle does not function properly, it can lead to esophageal health problems such as acid reflux, gastroesophageal reflux disease (GERD), and achalasia. Other issues with the esophagus may arise as well.
What Is Esophageal Hematoma?
Intramural esophageal hematoma (IEH) is a rare cause of submucosal esophageal bleeding that occurs alongside mucosal tears (Mallory-Weiss syndrome) and full-thickness perforation (Boerhaave's syndrome). It can occur as a result of coagulopathy (a condition where the blood's capacity to clot (coagulate) is compromised), trauma (foreign body ingestion or esophageal instrumentation), or spontaneously. It also can be caused by forceful vomiting or retching. It can also be iatrogenic, usually due to esophageal instrumentation, or it can occur without cause. It is characterized by a triad of chest pain, dysphagia (difficulty in swallowing), and hematemesis (a condition where patients internally bleed and then vomit as a result). However, the triad is present in only a few patients.
What Are the Causes of Esophageal Hematoma?
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Esophageal hematomas are raised purplish-red lesions that are mostly submucosal but occasionally obliterate the esophageal lumen. Depending on their etiology, they can be classified as either spontaneous or traumatic.
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Several types of esophageal hematomas are formed by intramural hemorrhages, including single or multiple localized hematomas and complete esophageal dissections. In addition, a hematoma can form spontaneously as a result of sudden changes in transmural wall pressure caused by coughing, retching, or prolonged vomiting, or it can be caused by iatrogenic procedures like esophageal variceal sclerotherapy or transesophageal ultrasonography.
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Patients with no or little history of esophageal barotrauma can also develop hematomas due to direct trauma from abrasive foods, such as taco shells, or pill-induced injury.
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Esophageal stricture, diverticulum, esophageal arteriovenous malformation, and Aspirin use are all possible causes. Most patients with esophageal hematomas affect older patients, though a few cases are reported in the younger. They appear mostly in females.
What Are the Signs and Symptoms of Esophageal Hematoma?
The most common symptom of an intramural esophageal hematoma is a sudden chest or retrosternal pain onset. The majority of patients have at least two of the classic triad of symptoms: retrosternal chest pain(a pain that originates in the chest), hematemesis, and dysphagia or odynophagia (pain while swallowing). Other symptoms of esophageal problems vary according to the cause. They can include:
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Swallowing difficulties (dysphagia).
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Chest ache.
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Regurgitation (food comes back into the mouth from the esophagus).
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A sensation or feeling of food getting stuck in the back of the throat.
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Cough.
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Sore throat or hoarseness.
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Vomiting or spitting up blood.
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Bad breath or halitosis.
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Loss of weight.
How to Diagnose Esophageal Hematoma?
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Upper Endoscopy - The doctor will insert a flexible tube with a camera on the end (endoscope) into the throat and esophagus. An endoscope can detect issues in the esophagus, stomach, and the first part of the small intestine (duodenum).
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Biopsy - The physician will collect tissue samples from the esophagus lining. The tissue samples will be examined under a microscope by a pathologist.
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Barium Swallow - The healthcare provider will use a type of X-ray called fluoroscopy to perform the barium swallow. Patients will be required to drink a chalky-tasting liquid containing barium. Barium is a substance that causes certain parts of the body to appear more clearly on X-rays.
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Esophageal pH Test - The physician will insert a thin tube (catheter) into the esophagus. This test determines how frequently and for how long stomach acid enters the esophagus.
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MRI (Magnetic Resonance Imaging) - It is a painless test that produces clear images of the organs and structures in the body structures
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Computed Tomography (CT) Scan - It is an effective diagnostic tool for identifying diseases and injuries.
How to Treat Esophageal Hematoma?
Dysphagia may be present in the patient. The hematoma will typically unexpectedly deteriorate, so special treatment is rarely needed.
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Conservative Therapy- This results in an excellent prognosis for spontaneous intramural hematoma. Esophageal hematomas usually disappear within two to three weeks with no long-term consequences. However, consultations with cardiology, gastroenterology, and thoracic surgery specialists may be required.
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Soft Diet- In stable patients, a soft diet can be started and gradually advanced based on symptom improvement.
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Surgical Intervention- It is usually reserved for patients who have massive hemorrhages or have become hemodynamically unstable.
Other common medications for esophagus conditions include
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Antacids (neutralize stomach acids).
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Acid blockers decrease acid production.
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Proton pump inhibitors (stronger acid blockers that help heal the esophagus tissue).
Some conditions may necessitate specialized procedures or surgery to resolve. These include esophageal dilation and esophageal resection. The severity of the disease usually determines treatment for esophageal cancer.
What Is the Complication Related to Esophageal Hematoma?
The most common complication is bleeding, which is caused after the rupture of the hematoma. In some instances, the hematoma gets expanded, causing esophageal luminal obstruction.
What Is the Prognosis of Esophageal Hematoma?
Esophageal hematoma is a beginning condition where the patients recover with a conservative method of treatment. This condition has a good prognosis.
Conclusion
Intramural esophageal hematoma is a rare condition that is more common in older women and can be misdiagnosed as a cardiovascular or digestive emergency. Chest pain, sudden dysphagia or odynophagia, and minor hematemesis are the classic clinical triad. Valsalva maneuver, blunt, direct, or iatrogenic injuries are known precipitating factors, but spontaneous cases have also been described.
Upper gastrointestinal endoscopy and computed tomography (CT) or magnetic resonance imaging (MRI) are useful diagnostic tools. The treatment is conservative, and the prognosis is usually excellent, with full resolution occurring within a few weeks.
