Esophageal Disorders

Esophageal disorders are problems that impact how your esophagus works. Your esophagus is an important part of your digestive system. It’s a tube that helps food travel from your mouth to your stomach. If you have an esophageal disorder, something is getting in the way of this process.

Symptoms depend on the type. But they can disrupt everyday life. In some cases, making changes to your daily routine can help you feel a little better. Treatment can also include medications and surgery.

Types of esophageal disorders

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder. It happens when the lower esophageal sphincter doesn’t close properly. This causes stomach acid and contents to flow backward into your esophagus.

Other esophageal disorders include:

• Achalasia: This is the opposite problem as GERD — the lower esophageal sphincter doesn’t relax, and food doesn’t empty into the stomach well.
• Barrett’s esophagus: Chronic, untreated acid reflux can lead to inflammatory changes in your esophagus that may be precancerous.
• Eosinophilic esophagitis: This is an allergic reaction to food allergens that causes chronic inflammation in your esophagus. Chronic inflammation leads to scarring and narrowing.
• Esophageal cancer: Cells in your esophagus make more of themselves than they should. These cancerous cells can spread to other organs and be deadly.
• Esophageal diverticulum: A pocket or outpouching forms on a weak spot in your esophagus.
• Esophageal spasms: Abnormal muscle spasms happen in your esophagus. This can make it harder to get food down. They can also be painful.
• Esophageal strictures: Over time, your esophagus becomes unusually narrow. Swallowing may be harder.
• Hiatal hernias: The top of your stomach pushes up through an opening in your diaphragm and into your chest.

Symptoms of esophageal disorders

Your symptoms depend on the type of esophageal disorder you have. You may have:

• Abdominal pain, chest pain or back pain
• Chronic cough or sore throat
• Difficulty swallowing or feeling like you have food stuck in your throat
• Heartburn (burning feeling in your chest)
• Hoarseness or wheezing
• Indigestion (burning feeling in your stomach)
• Regurgitation (stomach acid or contents coming back up your esophagus to your mouth) or vomiting
• Unexplained weight loss

Esophageal disorder causes

Causes of esophageal disorders largely vary by type. Some disorders can develop after you have an allergic reaction. Others are passed down from biological parent to child. And sometimes, providers don’t know the causes.

Risk factors

Factors that increase the chances of developing an esophageal disorder include:

• Alcohol use
• Extra weight due to obesity or pregnancy
• Medications, including certain antibiotics, antidepressants and pain relievers
• Radiation therapy to your neck or chest
• Smoking, including exposure to secondhand smoke

Complications of esophageal disorders

Regurgitation may cause food to go into your trachea (windpipe) and lungs. This is called aspiration. It can lead to pneumonia and lung infections. Swallowing problems also make you more prone to malnutrition and dehydration.

Some esophageal disorders, like GERD and achalasia, can increase your risk of cancer if you don’t get treatment.

How doctors diagnose esophageal disorders

Your healthcare provider will ask about your symptoms and do a physical exam. They may feel your neck while you swallow.

They may use these tests to help diagnose your esophageal disorder:

• Upper endoscopy examines the upper part of the digestive tract using a long, thin scope. Your provider may also do a biopsy. For this, they’ll take tissue samples and look for signs of inflammation, cancer and other diseases.
• Gastrointestinal X-rays (barium swallow) use imaging to see how a liquid barium solution flows through your esophagus and digestive tract.
• Esophageal manometry measures how well the muscles in your esophagus and lower esophageal sphincter work as you swallow a liquid.
• Esophageal pH test measures the amount of stomach acid (pH levels) in your esophagus.

How are esophageal disorders treated?

Treatments for esophageal disorders depend on the condition.

Medications may include:

• Antacids, proton pump inhibitors and histamine receptor (H2) blockers to reduce stomach acid
• Botulinum toxin (Botox®) injections to temporarily stop esophageal spasms or relax the sphincter muscle

Procedures may include:

• Endoscopic dilation to open a narrowed esophagus or relax a sphincter muscle
• Esophagectomy surgery to remove part or all of a diseased esophagus
• Heller myotomy and peroral endoscopic myotomy (POEM) to treat achalasia and esophageal spasms
• Laparoscopic antireflux surgery (fundoplication) to treat GERD or a hiatal hernia by reinforcing the lower esophageal sphincter

When should I see my healthcare provider?

Reach out to your provider if you’re taking medications or had surgery and experience:

• Redness or warmth around your incisions
• Trouble swallowing
• Pus coming from the surgery site
• Worsening pain that medications aren’t helping
• Shortness of breath
• Fever

What can I expect if I have an esophageal disorder?

If you have an esophageal disorder, you may find symptom relief with over-the-counter (OTC) or prescription medications. Surgery is also an effective treatment for disorders like hiatal hernia and esophageal spasms.

It’s important to stick to any daily habits your provider recommends, like eating smaller meals and staying physically active. These can go a long way in helping you feel better.

What questions should I ask my provider?

You may want to ask your healthcare provider:

• What type of esophageal disorder do I have?
• What caused my esophageal disorder?
• What’s the best treatment for my esophageal disorder?
• How can I modify my habits to protect my health?
• Should I look out for complications?

How can I prevent esophageal disorders?

Esophageal disorders aren’t always preventable. But you may be able to lower your risk of getting them by:

• Not eating late at night
• Allowing at least three hours between eating and lying down
• Eating fatty foods in moderation, as well as onions, garlic and chocolate
• Eating smaller meals throughout the day and taking your time with them
• Limiting caffeine and alcohol
• Quitting smoking and using tobacco products, if you do
• Elevating your head when you sleep
• Staying active and maintaining a healthy weight for you