Diseases of the esophagus

The esophagus can be affected by several different diseases. Symptoms such as bad breath or difficulty swallowing can be an important clue in the search for the underlying disease.
The treatment options are varied and always based on the diagnosed disease.

Damage and injury to the mucous membrane

heartburn

The most common disease of the esophagus is the reflux of gastric acid due to decreased muscle closure between the esophagus and the stomach. Gastric acid causes inflammation of the esophageal mucosa.
Patients' complaints are frequent belching, the so-called heartburn and recurring burning pain behind the breastbone. In medical terminology this is referred to as reflux disease or reflux oesophagitis.

esophagitis

An esophagitis ( esophagitis ) refers to an inflammation of the mucous membrane of the esophagus. This inflammation can be caused by various causes, such as bacteria. Probably the most common cause is a recurrence of heartburn. The mucous membrane of the esophagus is very sensitive to gastric acid, causing it to become inflamed and irreversibly altered.

Mallory-Weiss syndrome

Mallory-Weiss syndrome is a condition characterized by bleeding from the torn mucosal lining of the esophagus. The affected patients suffer from severe upper abdominal pain and vomit, among other things, blood ( hematemesis).
The Mallory-Weiss syndrome is triggered by recurrent vomiting. The dermal membrane is damaged in this way and breaks in some places. Especially alcoholism is characterized by frequent vomiting, which is why the syndrome often occurs in alcoholic patients. But also reflux oesophagitis can lead to this disease.

esophageal varices

An esophageal variceal bleeding describes severe bleeding from the esophageal varices. The Krampadern arise secondary. That is, they arise as a result of an underlying condition such as liver function disorders. The pressure in the venous system increases sharply and it can lead to life-threatening bleeding, which should be supplied immediately.
Esophageal varices are usually not symptomatic and are only discovered when bleeding.

Diseases of the esophagus

achalasia

Achalasia describes a disorder of the muscles of the esophagus, which is accompanied by a Tonusverminderung of the musculature. This leads to a worsened opening of the sphincter. In this way, the swallowing process of the esophagus is impaired and the chyme can not be carried into the stomach. It only comes to an emptying when the pressure due to pent-up food is large enough and the sphincter then opens this.
The affected patients complain of dysphagia, weight loss and pain behind the sternum.

esophageal spasm

A similar but considered as a separate disease, is the diffuse esophageal spasm. This leads to simultaneous and repeated contraction of the smooth muscle of the esophagus. The normal wave-like movement, which carries the food towards the stomach, is found only in the upper section, the rest of the esophagus contains numerous turns and bulges and looks similar to a corkscrew in x-ray examinations with contrast medium.
Due to these deformities, the esophagus shortens tremendously and, in addition, it causes the stomach to pull up through the diaphragm.

esophageal stricture

This disease is caused by a narrowing of the esophagus, whereby the food can no longer be adequately transported. Mostly the lower section is affected. There are manifold causes known for the emergence. It is most commonly associated with reflux disease. But also inflammatory reactions that are triggered by bacteria, can lead to this disease.
Patients complain of dysphagia (dysphagia) and pain.

reflux

Reflux disease describes the backflow of stomach acid into the esophagus. The most common cause of this is the incomplete occlusion of the lower oesophageal sphincter. Other causes may be pregnancy or surgery.
Inflammation of the esophagus or even precancerous lesions (precursors of cancer) can occur as a result of the reflux.

The main symptom of reflux disease is heartburn. A burning pain behind the sternum, which occurs especially after meals, at night and while lying down. There may also be a feeling of pressure behind the breastbone.

esophageal cancer

Another important and not uncommon disease is esophageal cancer.
Patients with risk factors such as alcohol, cigarette consumption and imbalanced nutrition are at higher risk for the disease.
Other diseases of the esophagus also contribute to the development of cancer. Reflux disease in particular, which in many cases leads to frequent inflammations of the mucous membrane, increases the risk of cancer cells forming due to changes in the mucosa. Such changes or remodeling processes of the mucosa are generally referred to as metaplasia and promote the development of cancer.
Patients often notice that there are changes only from a greater degree of impairment, such as dysphagia. Furthermore, hoarseness, pressure and pain behind the sternum and B symptoms may occur. The diagnosis of food tube cancer is usually made by means of a detailed anamnesis and various examinations.

Speiseröhrendivertikel

Another very rare disease of the esophagus is anatomical esophageal outgrowth. They are referred to as esophageal diverticulum and occur as different sized bulges in different areas of the esophagus. Due to a weakened muscular gap and with simultaneous pressure increase in the abdomen as when lifting heavy objects, this bulge can come.
The patient usually notices symptoms of diverticula above a certain size. There are more frequent dysphagia, which can lead to choking up of undigested food. Another unpleasant symptom is intense halitosis when food dehydrations remain in these protuberances and are not swallowed. Patients have the constant feeling that they have a lump in their throats. By examining the esophagus with an endoscope and possibly also contrast medium, the diverticula can be diagnosed.

hernia

If a part of the stomach slips through the diaphragm into the chest, this is called sliding hernia, diaphragmatic hernia or hiatal hernia. Here it comes to a similar symptomatology as with the achalasia. Diaphragmatic fractures may also be the sole cause of heartburn and air burst.
However, in most cases, sliding hernias are without discomfort, and only in complicated forms can severe complications such as entrapment, bleeding, and tears arise. '
Depending on the size of the fracture and depending on the size of the stomach displaced into the chest, an operation is performed. The part of the stomach is moved back into the abdomen and finally fixed with a cuff and its own stomach tissue.

Surgery and Treatment for Diseases of the Esophagus | Dr. Richard Battafarano Q&A (December 2019).


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