Symptoms of esophageal narrowing

The symptoms of a narrowing of the esophagus are mainly determined by the restricted transport of food into the stomach. Those affected typically find it more difficult to swallow food (dysphagia), as the body tries to overcome the increased pressure caused by the narrowing in the esophagus by swallowing more forcefully. Pain may also occur when swallowing.

The difficulty in swallowing is hardly noticed in the initial phase of the disease and only occurs to some extent when swallowing solid food.Affected persons then often drink more water to better flush the food down the toilet. In addition to swallowing difficulties, heartburn, a burning to painful feeling behind the breastbone, as well as increased belching and bad breath, can occur. Burping occurs mainly in a lying position, which results in the burping of undigested food.

When lying down, gravity does not play its part in transporting the food towards the stomach, making burping easier. When the food is stored in front of the esophageal narrowing, the food there is increasingly digested by bacteria, which is why the bad breath associated with the narrowing occurs. Weight loss can also be accompanied by a narrowing of the esophagus. If it is an advanced clinical picture, food that has already been swallowed can even get back into the mouth, this is called regurgitation.

Treatment of a narrowing of the esophagus

Treatment of esophageal narrowing is necessary in any case if the symptoms are perceived as very restrictive by the patient. Since a narrowing of the esophagus is usually the result of an underlying disease, such as reflux, it is often necessary to treat it in order to lead to a secondary reduction of the narrowing of the esophagus. The frequently triggering reflux disease is usually treated by the administration of so-called proton pump inhibitors such as Pantoprazole.

These serve to reduce the production of gastric acid. If bacterial inflammation of the esophagus is the trigger factor, it is treated with antibiotics. If the pathogen is fought efficiently, the narrowing of the esophagus should also disappear on its own.

If the narrowing of the esophagus is caused by achalasia, i.e. a spasm of the lower sphincter muscle, a conservative, i.e. non-surgical, course of therapy is chosen first. For this purpose, drugs are administered to relax the sphincter muscle.

Nifedipine, for example, is used for this purpose, which is normally used to treat high blood pressure. Nifedipine is an antagonist of calcium, which mediates muscle contraction. The drug must be taken half an hour before food intake to ensure that the muscles of the esophagus relax in time.

Often, however, a conservative therapy in the context of achalasia does not work or the effect wears off after a certain time. Surgery for a narrowing of the esophagus is necessary, for example, if there is a tumor causing it, which is removed during the operation. Another indication for surgery is when the esophageal narrowing cannot be corrected by treatment of the underlying disease, as in the case of achalasia.

In this case an esophageal dilatation is performed. This is typically done with the help of a small balloon that is inflated practically inside the esophagus to dilate it. This procedure does not require major surgery with opening of the chest, the operation can be performed using a camera system with the mouth as the access.

The whole procedure can therefore be performed as part of a gastroscopy, so it is not an operation in its own right. Often this procedure has to be repeated in order to reopen the dilation of the esophagus. In addition to the mechanical widening of the esophagus by the balloon procedure, in the case of achalasia, Botox can also be injected into the muscle during a gastroscopy, causing the muscle to relax for a certain period of time.

While the procedures mentioned above often have only a temporary effect, a special operation can also cause a permanent dilatation of the esophagus. For this operation, the lower sphincter muscle is split using ultrasound. Afterwards, the position of the esophagus and the stomach entrance may have to be changed and connected.

This procedure is a major operation that cannot be performed as part of a gastroscopy, but rather endoscopically, i.e. by inserting a camera system and various surgical tools through several small skin incisions. If esophageal cancer is the indication for surgery, the entire esophagus is often removed. To compensate for the missing esophagus, the stomach is surgically pulled upwards so that the food reaches the stomach directly via the pharynx.This operation is a very large operation, which is subsequently accompanied by limitations of the patient.