Disorders of the Oesophagus - An Overview

What Are the Disorders of the Oesophagus?

The esophagus carries food through the mouth into the stomach. Each swallow is followed by synchronized (peristaltic) contractions that carry out this function. The esophagus normally does not contract between swallows. The muscle that separates the esophagus from the stomach is known as the lower esophageal sphincter, or LES. It functions like an opening that is often kept securely closed to stop stomach contents from backing up down the esophagus. The LES facilitates stomach access to food it expands (the muscle relaxes) during swallowing. An esophageal motility issue may cause symptoms such as the inability to swallow fluids or substances, heartburn, regurgitation, and unusual or non-cardiac chest pain.

What Are the Types of Oesophagus Disorder?

Esophageal disorders include the following:

• Gastroesophageal Reflux Disease - While the lower sphincter of the esophagus fails to close adequately, the most prevalent esophageal disorder, gastroesophageal reflux disease (GERD), occurs. As a consequence, acid from the stomach and its contents reflux into the esophagus.

• Achalasia - The lower sphincter of the esophagus does not relax or open, prohibiting food from entering the stomach. Achalasia is a form of autoimmune illness, but the precise cause is unknown. The nerves that regulate the esophageal muscles are compromised.

• Barrett’s Esophagus - In individuals with prolonged, uncontrolled acid reflux, the inner layer of the lower esophagus begins to resemble the stomach lining, along with the cells within it that start mimicking intestinal cells. Where the esophagus and stomach meet, these modifications occur. This disease is associated with a higher risk of esophageal cancer.

• Esophagitis - In eosinophilic esophagitis, the esophagus becomes overrun by an assortment of white blood cells called eosinophils. As a result, the membrane of the esophagus becomes inflamed or swollen (esophagitis). Multiple allergy sufferers are more susceptible to this condition.

• Cancer of the Esophagus - It consists of two subtypes: squamous cell carcinoma and adenocarcinoma. In general, smoking, radiation, and HPV (human papilloma virus) infection increase the risk of esophageal squamous cell carcinoma, whereas smoking and acid reflux increase the risk of esophageal adenocarcinoma.

• Diverticula - In the case of an esophageal diverticulum, an outpouching occurs in a vulnerable area of the esophagus. Diverticula are more prevalent in individuals with achalasia.

• Esophageal Convulsions - The esophagus experiences abnormal muscle spasms (contractions). This uncommon, excruciating condition prevents meals from reaching the intestines.

• Esophageal Strictures - These occur when the esophagus narrows excessively. The passage of food and liquids to the stomach is gradual.

• Hiatal Hernias - The upper portion of the gastrointestinal system protrudes through a cavity in the diaphragm and resides in the thorax. This condition causes acid reflux to worsen.

What Are the Symptoms of the Conditions?

The several types of esophageal disorders each have their own unique set of symptoms. The patient may experience:

• Back pain, chest pain, or abdominal pain are the types of discomfort that may be experienced.

• The patient suffers from a persistent cough or throat discomfort.

• Having trouble swallowing or having the sensation that when food becomes stuck in the throat, it may be very uncomfortable.

• The thoracic discomfort known as heartburn causes a burning sensation.

• Having trouble breathing or a raspy voice.

• A burning sensation in the stomach is referred to as indigestion.

• Vomiting or regurgitation, is the process of stomach acid or food traveling backward down the esophagus to the mouth.

• Loss of weight for no apparent reason.

Which Are the Diagnostic Tests?

The following procedures are included in the diagnostic testing for esophageal disorders:

• Endoscopy - A lengthy and slender scope is used during an upper endoscopy examination, which looks at the upper portion of the digestive tract.

• Biopsy - The healthcare professional may also obtain tissue samples to perform a biopsy and examine them for indications of inflammation, cancer, and other disorders.

• Barium Swallow Test - During a barium swallow test, also known as a gastrointestinal X-ray, imaging is used to observe as a liquid barium fluid travels through the esophagus and the digestive tract.

• High-Resolution Esophageal Manometry - A method called high-resolution esophageal manometry evaluates whether esophageal muscles contract and relax after swallowing, which is a sign of how well the esophagus is working. This enables gastroenterologists to identify the true source of symptoms and provide an efficient course of treatment.

• Endoscopic Ultrasonography - The process known as endoscopic ultrasonography, or EUS, combines endoscopy and ultrasound to produce detailed pictures of the digestive system. Esophageal cancer is staged, and Barrett's esophagus is frequently diagnosed using this test.

• Fiberoptic Endoscopic Examination - Swallowing function is evaluated by fiberoptic endoscopic examination of swallowing, or FEES. The act of swallowing food is captured on video by a catheter that is inserted into the throat.

• Esophageal Manometry Test - While swallowing a drink, an esophageal manometry test will determine how efficiently the muscles in the esophagus and the lower esophageal sphincter are working.

• pH Test - A pH (potential of hydrogen) test of the esophagus determines how much acid from the stomach is present in the esophagus as well as its pH level.

What Are the Risk Factors?

Multiple risk factors may play a role in the development of an esophageal problem, including the following:

• Use of alcoholic beverages.

• An excessive amount of weight brought on either obesity or pregnancy.

• Medication may include certain antibiotics, antidepressants, and pain medications, among others.

• The administration of radiation therapy is administered to the chest or neck.

• Tobacco use in any form, including passive inhalation of secondhand smoke.

What Is the Treatment Method?

• Medications - To treat the symptoms of GERD, such as heartburn, it is common practice to take medication in addition to making adjustments to one's lifestyle. It is possible that the doctor would suggest beginning by trying over-the-counter drugs that can help regulate acid. A medicine is known as an H-2-receptor blocker, which lowers acid production, or a proton pump inhibitor, which blocks acid production and can help the esophagus recover. Both of these treatments lessen the amount of acid that is produced.

• Esophageal Balloon Dilation - Through a process known as esophageal balloon dilation, physicians will be able to enlarge a constricted section of the esophagus by employing a specialized balloon that is attached to an endoscope. When the balloon is inflated, it extends the part of the esophagus that has contracted to an unhealthy degree and allows for more space.

• Laparoscopic Heller Myotomy - Achalasia can be treated with a surgical treatment called a laparoscopic Heller myotomy, which is a minimally invasive operation.

• Minimally Invasive Esophagectomy - The esophagus can be removed by whole or in part surgical operation known as a minimally invasive esophagectomy. After it has been surgically removed, the esophagus will be reconstructed using tissue from either the stomach or the large intestine. Patients diagnosed with Barrett's esophagus or cancer of the esophagus are typically the only candidates for this treatment.

• Cryotherapy - The treatment of Barrett's esophagus or esophageal cancer in its early stages frequently involves the use of cryoablation, which is also known as cryotherapy. During the operation, a spray of liquid nitrogen is sent into the esophagus to freeze and destroy any precancerous or cancerous tumors that may be present.

• RFA Therapy - RFA (Radiofrequency ablation) therapy, commonly known as radiofrequency ablation, is another treatment option for Barrett's esophagus. It makes use of thermal energy, often known as heat, to destroy precancerous lesions by burning them.

• Surgical Procedure - A surgery called endoscopic mucosal excision is performed to remove diseased or malignant tissue within the gastrointestinal tract. This includes the esophagus, the stomach, and the colon.

• Anti-reflux Surgery - Treatment for gastroesophageal reflux disease (GERD) is known as minimally invasive fundoplication, often known as anti-reflux surgery. When a patient has tried every other form of treatment, such as medicine, and attempts to alter their lifestyle, they frequently turn to this treatment method.

• TIF Operation - Chronic acid reflux can also be treated with surgery that does not require any incisions. The Transoral Incisionless Fundoplication, or TIF operation. While general anesthesia is still acting on the patient, a specialized instrument known as an EsophyX is linked to the endoscope and subsequently maneuvered into the mouth. Surgeons can use it to strengthen a weak sphincter in the esophagus.

Conclusion

Esophageal problems impact the esophagus, which is the passage connecting the oral cavity to the intestines and moves food down to the stomach. This condition, known as aspiration, has been linked to the development of pneumonia and other lung infections. In addition, when there is trouble swallowing, the child is more likely to become malnourished and dehydrated. Medications available over the counter can offer symptomatic relief to those suffering from esophageal diseases. Surgical intervention may be required to treat certain disorders, such as cancer of the esophagus or achalasia. Changes in food and lifestyle, together with medical treatment, are often necessary to keep symptoms under control.