Diseases of the Digestive System - The esophagus

Varices

Varices (singular: varix ) are enlarged and congested veins that appear in the esophagus because of increased blood pressure to the liver in patients with liver cirrhosis. This disease is most common in chronic alcoholics. Esophageal varices can be complicated by erosion of the mucous lining of the esophagus as a result of inflammation or vomiting. This causes hemorrhaging of the thin-walled veins, which can be fatal.

Bleeding esophageal varices may require hospitalization, immediate blood transfusions, and surgery.

Hiatus Hernia

The lower end of the esophagus or part of the stomach can sometimes protrude through the diaphragm. This hiatus hernia , sometimes referred to as a diaphragmatic hernia , can be a result of congenital malformation; in adults, the principal cause is weakness of the muscles around the opening of the esophagus leading into the stomach.

In individuals who are obese and who have large stomachs, the stomach contents may be forced back into the lower esophagus, causing this area to herniate. Other causes include stooping, bending, or kneeling, which increases pressure in the stomach. Pregnancy may increase abdominal pressure in the same manner as obesity.

Typical symptoms are vomiting when the stomach is full, heartburn with pain spreading to the ears, neck, and arms, swallowing difficulty with the food sometimes sticking in the esophagus, and a swollen abdomen. The vomiting may occur at night, with relief obtained by getting up and walking about for a few minutes. Belching will relieve the distension, and antacids (acid neutralizers) may be prescribed to counter gastric hyperacidity.

Conservative treatment involves eating small portions at frequent intervals. Dieting and a reduction in weight cause the symptoms to disappear. When the symptoms are due to pregnancy, they disappear after delivery. When medical management is not successful, surgical repair of the hernia is necessary. See also “Hernias” later in this chapter.

Achalasia

Achalasia is abnormal dilation of the lower esophagus caused by failure of the cardiac sphincter to relax and allow food to enter the stomach. Food collects in the esophagus and does not flow into the stomach. The patient feels as though the food is sticking in the middle of his chest wall. Small amounts of food may eventually pass into the stomach, and the mild pain or discomfort disappears.

If the condition persists, the pain may increase to become a continuous burning sensation at each meal, due to inflammation of the esophagus by accumulated food. If the patient lies down, some of this esophageal content will regurgitate and enter the pharynx. If the vomitus gets into the lungs, the end result may be aspiration pneumonia , a form of pneumonia caused by inhaling particles of foreign matter.

The disease is difficult to control, and the condition tends to return, so that surgery is often used to create a permanent opening between the esophagus and stomach.

Swallowing Difficulty

Difficulty in swallowing is called dysphagia , which should not be confused with dysphasia , a speech impairment. Dysphagia may be caused by lesions in the mouth and tongue, acute inflammatory conditions in the oral cavity and pharynx (mumps, tonsillitis, laryngitis, pharyngitis), lesions, cancers, or foreign bodies in the esophagus. Strictures in the esophagus—from esophageal ulcers or from swallowing corrosive liquids—will also impair swallowing.