Diseases of the esophagus
Achalasia describes a disorder of the musculature of the esophagus, which is accompanied by a decrease in muscle tone. This leads to a deteriorated opening of the sphincter muscle. In this way, the swallowing process of the esophagus is impaired and the chyme cannot be transported into the stomach.
Emptying does not occur until the pressure is high enough due to accumulated food and the sphincter opens. The affected patients complain of swallowing difficulties, weight loss and pain behind the breastbone. A similar but considered a separate disease is diffuse esophageal spasm.
This involves simultaneous and repeated contractions of the smooth muscles of the esophagus. The normal wave-like movement, which transports food towards the stomach, is only found in the upper part of the esophagus, the rest of the esophagus contains numerous turns and bulges and looks like a corkscrew when examined with contrast medium. Due to these deformities, the esophagus is shortened enormously and the stomach is also pulled up through the diaphragm.
This clinical picture is caused by a narrowing of the esophagus, as a result of which food can no longer be adequately transported. Mostly the lower section is affected. There are many known causes for its development.
Most often it occurs in connection with a reflux disease. But also inflammatory reactions, which are triggered by bacteria, can lead to this clinical picture. Patients complain about swallowing disorders (dysphagia) and pain.
The reflux disease describes the backflow of stomach acid into the esophagus. The most common cause of this is the incomplete closure of the lower esophageal sphincter. Other causes can be pregnancy or surgical interventions.
An inflammation of the esophagus or precancerous lesions (precursors of cancer) can occur as a result of reflux. The main symptom of reflux disease is heartburn. A burning pain behind the breastbone, which occurs especially after meals, at night and when lying down.A feeling of pressure behind the sternum may also occur.
Another important and not seldom occurring disease is esophageal cancer. Patients with risk factors such as alcohol and cigarette consumption and an unbalanced diet have a higher risk of the disease. Other diseases of the oesophagus also contribute to the development of cancer.
Especially reflux disease, which in many cases leads to frequent inflammations of the mucous membrane, increases the risk of cancer cells forming in the mucous membrane due to transformations. Such changes or remodelling processes of the mucosa are generally called metaplasia and promote the development of cancer. Patients often only notice the presence of changes after a more severe impairment such as swallowing difficulties.
In addition, hoarseness, a feeling of pressure and pain behind the breastbone and B-symptoms can occur. The diagnosis of cancer of the oesophagus is usually made by means of a detailed anamnesis and various examinations. Learn more about esophageal cancer hereA further but quite rare disease of the esophagus are anatomical bulges of the esophagus.
They are called esophageal diverticula and occur as bulges of varying sizes at different locations in the esophagus. Due to a muscularly weakened gap and a simultaneous increase in pressure in the abdominal cavity as when lifting heavy objects, this bulge can occur. The patient usually notices symptoms only after a certain size of diverticulum.
Swallowing difficulties occur more frequently, which can even lead to the regurgitation of undigested food. Another unpleasant symptom is intense bad breath if chunks of food remain in these bulges and are not swallowed. Patients constantly have the feeling of having a lump in their throat.
The diverticula can be diagnosed by means of an examination in which the oesophagus is visualized with an endoscope and possibly a contrast medium. If a part of the stomach slides through the diaphragm into the chest cavity, this is called sliding hernia, diaphragmatic hernia or hiatal hernia. Here the symptoms are similar to those of achalasia.
Diaphragmatic hernia can also be the sole cause of heartburn and air bursts. In most cases, however, sliding hernia is without symptoms and only in complicated forms can more serious complications such as incarcerations, bleeding and tears occur. Depending on the size of the fracture and the size of the stomach displaced into the chest cavity, surgery is performed. During this procedure, the part of the stomach that has been relocated back into the abdomen is moved back into the chest and finally fixed with a cuff also of the patient’s own stomach tissue.
