Esophageal diseases - Information & specialists

Symptoms such as difficulty swallowing or heartburn can indicate a disease of the oesophagus. Possible esophageal diseases include functional disorders, inflammation or tumors of the esophagus.

Background information on esophageal diseases

The oesophagus is an elastic muscular tube that is closed at the upper and lower ends by a sphincter muscle (oesophageal sphincter). The esophagus consists of squamous epithelial cells.

The upper sphincter prevents air from entering when swallowing. The lower sphincter protects the oesophagus from reflux of stomach contents. The esophagus transports food from the pharynx to the stomach.

After swallowing, the two sphincters open. The longitudinal and circular muscles (peristalsis) ensure undulating phases of contraction and relaxation.

All sections and functional units of the oesophagus can be impaired and cause discomfort.

Doctors divide esophageal diseases into

• Functional disorders of the oesophagus (achalasia, oesophageal spasm)
• GERD = Gastro-Esophageal Reflux Disease(reflux disease)
• Oesophagitis (inflammation of the oesophagus)
• Oesophageal diverticulum (abnormal protrusion of the wall)
• Tumors of the oesophagus
• Emergencies (chemical burns caused by alkalis or acids)

You should have any complaints clarified as soon as possible. Swallowing difficulties in particular have a long-term effect on your nutritional status and therefore reduce your quality of life. In addition, persistent swallowing problems may indicate cancer, which your doctor should diagnose as soon as possible.

Typical symptoms of esophageal diseases

Dysphagia, regurgitation (reflux of food) and heartburn are characteristic symptoms of esophageal diseases. However, pain behind the breastbone (retrosternal pain) is also often a sign of oesophageal disease.

The reason for the discomfort is often inflammation.

If left untreated, heartburncan lead to inflammation of the oesophagus (oesophagitis) @ Henrie /AdobeStock

Reasons for the inflammation can be

• Reflux disease
• Pathogens
• Physical or chemical stimuli

If the nerve cells in the lower section of the oesophagus are damaged, the lower sphincter can no longer relax (achalasia).

Cramp-like muscle contractions in the overlying section of the esophagus (esophagospasm, nutcracker esophagus, jackhammer esophagus) are also possible.

In both cases, the food gets "stuck in the throat", so to speak. This leads to violent coughing attacks, regurgitation and retrosternal pain.

Causes & risk factors for esophageal diseases

Esophageal disease can have various causes.

These can be

• Anatomical changes (including hiatal hernia = abnormal protrusion of a part of the stomach through the diaphragm)
• Tumor diseases or
• inflammations

Unfavorable lifestyle and dietary habits promote esophageal disease.

The risk factors include

• High nicotine and alcohol consumption
• High-fat, acidic and sweet foods
• Stress

Taking certain medications also has a negative effect on the oesophagus.

Medications include:

• Calcium channel inhibitors
• Anticholinergics
• antihistamines

However, underlying diseases such as diabetes mellitus or Parkinson's disease, which have a negative effect on nerve function, also cause motility disorders.

In addition, allergic diseases sometimes lead to chronic inflammation of the oesophagus (eosinophilic oesophagitis).

Finally, swallowing disorders increase with age. Here, pronounced dry mouth (xerostomia), dehydration (exsiccosis) or poor dental status often also promote oesophageal disease.

Examination & diagnosis of esophageal disease

Depending on the initial suspicion, your doctor will diagnose esophageal disease using various examination methods.

Possible examination methods are

• Oesophagoscopy (endoscopy)
• X-ray examinations
• endosonography
• Motility tests(oesophageal manometry)
• Intraesophageal pH-metry

Oesophagoscopy (endoscopy)

During an esophagoscopy, the doctor looks at your esophagus through a fiberoptic endoscope. A fiberoptic endoscope is a thin, flexible tube with a light source and camera.

The doctor can take a smear using a cytology brush.

This method is used in particular for changes in the esophageal mucosa.

The changes occur with

• Heartburn
• oesophageal tumors
• Swallowing disorders (dysphagia) and
• varicose veins (oesophageal varices)

X-ray examination

An X-ray examination is the standard method for diagnosing esophageal diseases. Your doctor will x-ray your oesophagus to assess peristalsis, distensibility and the condition of the wall and mucous membrane.

Your doctor often performs the examination as a swallowing examination. During this examination, you drink a contrast medium one swallow at a time while your doctor takes X-ray images of your oesophagus.

The images provide information about

• the course and shape of the oesophagus and
• transition to the stomach

In achalasia, for example, the lower oesophagus has a champagne glass or S shape (later stage).

Achalasia of the esophagus @ bilderzwerg /AdobeStock

Endosonography

An ultrasound scan of the oesophagus provides cross-sectional images. This allows the doctor to identify superficial and deeper lesions in the wall layers. These lesions include a malignant tumor (carcinoma).

Motility tests (oesophageal manometry)

In oesophageal manometry, the doctor inserts a thin, flexible measuring catheter through the nose and oesophagus to the stomach. He then measures the pressure in the various sections of the esophagus while slowly withdrawing the catheter.

The doctor uses the recorded data to check the function of the oesophagus. For example, he can check whether the lower oesophageal sphincter has increased (achalasia) or decreased pressure(sphincter insufficiency).

Intra-oesophageal pH-metry

During this examination, your doctor measures the pH value in the area of the lower sphincter over a period of 24 hours. A low pH value indicates reflux disease, in which acidic stomach contents flow back into the esophagus.

Treatment of esophageal disorders

If possible, your doctor will treat an esophageal disorder causally to eliminate the underlying trigger.

In the case of achalasia, for example, medication (nifedipine, isosorbide dinitrate) can reduce the pressure in the lower section of the oesophagus in the early stages. However, they do not show good results in the long term.

The doctor therefore tends to treat the disease surgically.

Possible surgical procedures are

• Endoscopic balloon dilation
• Heller myotomy
• Peroral endoscopic myotomy

Alternatively, the doctor may recommend an endoscopic injection of botulinum toxin, as the drug reduces sphincter tone (tension in the ring muscle). However, the doctor must repeat the treatment every 6 to 12 months. It loses its effectiveness with frequent use.

Antispasmodics such as Buscopan can relieve the pain that occurs in attacks of esophageal spasm. As a preventative measure, your doctor may also prescribe medication (nitro preparations, calcium antagonists) that you take before meals.

If you have reflux disease, your doctor will try to reduce the reflux, which is aggressive to the oesophagus, with medication such as proton pump inhibitors (PPI). Antacids, which neutralize stomach acid, also alleviate typical accompanying symptoms (heartburn, belching).

If you do not respond to the therapy or if complications occur, surgical intervention is advisable. Laparoscopic fundoplication according to Nissen or Toupet is usually used.

In general, doctors rarely need to operate. The prognosis for reflux disease is also favorable, even if long-term therapy is usually required.

If pathogens have caused an inflammation of the oesophagus (oesophagitis), you will be given medication to eliminate the germs.

Your doctor will treat eosinophilic oesophagitis symptomatically with PPIs and steroids. You will also need to adjust your diet and avoid allergens.

Chemical burns require immediate endoscopic assessment and conservative treatment with antibiotics and a gastric tube. Any narrowing of the oesophagus (strictures) will later be widened by your doctor using an endoscope.

In the case of cancer(oesophageal carcinoma), treatment depends on the type and location of the tumor. The surgeon removes early and localized tumours surgically (endoscopic mucosal resection, submucosal dissection).

Your doctor will treatadvanced and inoperable tumors with a combination of radiotherapy and chemotherapy(radiochemotherapy). The 5-year survival rate for these treatment measures is 10 to 30 percent.

Esophageal diseases are treated by:

• Specialist in internal medicine
• Specialist in internal medicine with additional specialization in gastroenterology and hepatology
• Specialist in surgery (if surgery is required)
• Specialist in oncology and/or radiotherapy (for tumors)

Course and prognosis

The course and prognosis always depend on the esophageal disease. It is important that you have the symptoms clarified by a doctor at an early stage. This applies in particular to swallowing disorders and inflammation, as these increase the risk of cancer.

Conclusion

Esophageal diseases often cause similar symptoms, but can have very different causes. Your doctor can treat most conditions with medication or surgery so that they do not affect your quality of life.