Barrett’s Esophagus

Overview:
Barrett’s esophagus is a pre-cancerous condition affecting the lining of the esophagus, the tube that carries food from the mouth into the stomach. Gastroesophageal Reflux Disease (GERD) is a disorder in which stomach contents flow back up into the esophagus and cause injury to the esophageal lining. In some patients with long-standing GERD, the normal esophagus cells are damaged. Over time, this damage can result in inflammation and genetic changes that cause the cells to become abnormal. The tissue takes on a different appearance and is called intestinal metaplasia or Barrett’s esophagus.

Barrett’s esophagus increases the risk for a patient to develop esophageal cancer.

Symptoms:

Some patients with Barrett’s esophagus will experience the typical symptoms of GERD such as heartburn and indigestion. Others may have no symptoms at all.

Testing:

Patients with Barrett’s esophagus should have periodic endoscopic evaluation with biopsies looking for a condition called dysplasia, which places them at even higher risk for the development of esophageal cancer.

Treatment:

All patients should be treated with medications to decrease acid reflux into the esophagus. Some patients with dysplasia or early stage esophageal cancer may be candidates to have an endoscopic procedure called ablation to remove the diseased tissue to avoid progression to cancer. BARRX is a procedure performed during upper endoscopy to ablate (or coagulate) abnormal Barrett’s tissue by heating it until it is no longer viable or alive. Cryo Spray Ablation is a procedure performed during upper endoscopy. This technique removes unwanted tissue by freezing it with the spray of liquid nitrogen.

Difficulty Swallowing (Dysphagia)

Overview:

Difficulty Swallowing (Dysphagia) is a feeling that food is not passing appropriately from the mouth through the esophagus into the stomach.

Symptoms:

Transfer dysphagia, or oropharyngeal dysphagia, occurs when food or liquids do not pass out of the mouth into the beginning of the esophagus. This will often result in coughing, choking or a feeling of things going down the wrong pipe.

This is most likely to occur with nerve or muscle disorders such as a stroke or Parkinson’s disease. Esophageal dysphagia occurs when food or liquid does not pass through the esophagus into the stomach in a normal fashion. The patient will feel that things go down partially and then stick. Breathing is not affected as no food enters the windpipe. This problem may arise from a narrowing of the esophagus (stricture), inflammation of the lining of the esophagus or abnormal motor function of the muscles in the wall of the esophagus.

Testing:

Transfer dysphagia can best be evaluated and treated with the assistance of a speech pathologist using X-ray to evaluate the swallowing process. Esophageal symptoms can be further evaluated by barium x-rays or by passing a flexible tube into the esophagus (endoscopy) for direct visualization.

Treatment:

Dysphagia resulting from an esophageal stricture will typically respond to stretching or dilatation of the narrowed esophageal segment.

Eosinophilic Esophagitis

Overview:
Eosinophilic esophagitis is an inflammatory condition that causes difficulty swallowing.

Symptoms:

Patients often complain of food sticking in the esophagus and may at times require an emergency procedure to remove a piece of food lodged in the esophagus.

Testing:

The diagnosis is made with an endoscopy, which involves passing a flexible tube through the mouth into the esophagus to directly visual the lining of the esophagus and obtain tissue biopsy samples.

Treatment:

Eosinophilic esophagitis is likely caused by an allergic reaction to certain foods or other environmental agents. Treatment consists of avoiding these inciting factors or using medications such as steroids.

Esophageal Cancer

Overview:
Esophageal cancer is an abnormal growth or tumor that originates from the lining of the esophagus.

Symptoms:

Patients with esophageal cancer often complain of difficulty swallowing because the cancerous growth partially blocks the esophageal opening.

Testing:

Esophageal cancer is typically diagnosed by barium x-ray studies, or by passing a flexible tube through the mouth into the esophagus to directly look at the lining of the esophagus (a procedure called an endoscopy) and obtain biopsies.

Risk factors for esophageal cancer include tobacco use, alcohol consumption, and chronic gastroesophageal reflux disease (GERD).

Treatment:

Treatment options include surgery, chemotherapy, radiation therapy, and stent placement to relieve obstruction.

Esophageal Motility Disorders

Overview:
Esophageal motility disorders are diseases caused by abnormal esophageal muscle function.

The muscles in the wall of the esophagus contract and relax in an organized fashion to propel food from the mouth into the stomach.

Symptoms:

Abnormal muscle function can cause difficulty swallowing and sometimes even chest pain.

Testing:

Symptoms are typically initially evaluated by barium x-ray studies or by passing a flexible tube through the mouth into the esophagus to directly visual the lining of the esophagus (a procedure called an endoscopy).

Further investigation may include an esophageal motility study, which is a procedure to assess the motor or muscle function of the esophagus. During this procedure, a very thin, flexible tube is passed through the nose into the esophagus. The motor function of the esophagus can then be investigated as the patient swallows.

Treatment:

Treatment options include dietary modification and medications which promote appropriate esophageal muscle function.

Esophageal Stricture

Overview:
Esophageal Stricture is a narrowing of the esophagus, the tube that carries food from the mouth to the stomach. It is most commonly caused by longstanding irritation of the esophageal lining from reflux of stomach acid. Strictures may also be caused by cancer, radiation therapy or the ingestion of caustic liquids such as lye.

Symptoms:

Patients with an esophageal stricture typically complain of difficulty swallowing solid food (dysphagia). Liquids will pass easily but larger pieces of solid food will not pass through the narrowed segment of the esophagus.

Testing:

The diagnosis is made by barium x-ray studies or by passing a flexible tube through the mouth into the esophagus to directly visual the lining of the esophagus (endoscopy).

Treatment:

Dysphagia resulting from a noncancerous esophageal stricture will typically respond to stretching or dilatation of the narrowed esophageal segment.

Esophageal Varices

Overview:

Esophageal varices are enlarged veins that arise in the lower esophagus in patients with cirrhosis of the liver and other less common conditions. They resemble varicose veins of the legs.

Blood from the gastrointestinal tract normally flows through the liver. Scarring of the liver from cirrhosis prohibits normal blood flow and increases the pressure in the blood vessels. The veins swell, producing varices.

Symptoms:

Many patients with esophageal varices will have no symptoms. Severe bleeding can occur if the varices rupture. This often results in vomiting large quantities of blood and passing bloody bowel movements.

Testing:

All patients with cirrhosis of the liver should undergo periodic endoscopy to look for varices.

Treatment:

If varices are present medication can be used to lower the blood pressure within the varices to decrease the risk of bleeding. Active bleeding from varices can be controlled by passing a flexible tube through the mouth into the esophagus to directly visual the lining of the esophagus (endoscopy) to place rubber bands on the varices.

Esophagitis

Overview:

Esophagitis is an inflammation of the lining of the esophagus, the tube that carries food from the mouth to the stomach.

It is most commonly caused by stomach contents, including acid, traveling back up into the esophagus, a condition known as gastroesophageal reflux disease (GERD). Esophagitis can also be caused by infection with viruses or yeast, medications, or radiation therapy.

Symptoms:

Symptoms of esophagitis may include heartburn, pain with swallowing, or difficulty swallowing (dysphagia).

Testing:

Diagnosis it typically made by passing a flexible tube through the mouth into the esophagus to directly visual the lining of the esophagus (a process known as an endoscopy).

Treatment:

Treatment of esophagitis related to GERD is aimed at reducing reflux of acidic gastric material. This can usually be achieved through lifestyle modification, dietary changes, and medications to neutralize or inhibit the production of stomach acid. Infectious esophagitis is treated with medication that will eliminate the underlying infection.

Gastroesophageal Reflux Disease (GERD)

 

Overview:

Gastroesophageal Reflux Disease (GERD) is a common condition in which stomach contents travel back up into the esophagus, the tube that connects the mouth to the stomach.

At the lower end of the esophagus there is a muscular ring called the lower esophageal sphincter (LES). The LES should remain tightly closed except to allow food to pass normally into the stomach. Inappropriate relaxation of the LES allows stomach contents, including acid, to flow back into the esophagus.

Chronic reflux can cause complications such as esophageal ulceration, bleeding, stricture (narrowing of the esophagus) formation, and a precancerous condition called Barrett’s esophagus.

Symptoms:

Typical symptoms of GERD include heartburn and regurgitation.

More atypical symptoms include chest pain, cough, sore throat and laryngitis.

Testing:

GERD can usually be diagnosed on the basis of a patient’s symptoms.

Additional testing with barium x-rays, endoscopy or esophageal pH monitoring may be necessary in some cases to confirm the diagnosis or to evaluate and treat complications.

Treatment:

Certain lifestyle choices and foods can exacerbate reflux symptoms, so we recommend limiting these behaviors.

Exacerbating factors include spicy foods, acidic foods, chocolate, peppermint, caffeine, alcoholic beverages, tobacco products, overeating, and obesity.

Treatment is aimed at reducing reflux of acidic gastric material. This can usually be achieved through lifestyle modification, dietary changes, and medications to neutralize or inhibit the production of stomach acid.

Schatzki’s Ring

Overview:
Schatzki’s ring is a narrowing of the esophagus, the tube that carries food from the mouth to the stomach. It is a thin fibrous ring of tissue at the lower end of the esophagus that partially obstructs the esophagus just before it empties into the stomach.

Symptoms:

The patient will typically complain of long-standing, intermittent difficulty swallowing large pieces of food such as chicken, beef, or bread. The food will lodge in the lower esophagus but eventually pass into the stomach.

Testing:

The diagnosis is made by barium x-ray studies or by passing a flexible tube through the mouth into the esophagus to directly visual the lining of the esophagus (endoscopy).

Treatment:

The symptoms caused by a Schatzki’s ring will typically respond to stretching or dilatation of the ring during endoscopy.