The esophagus is a fibromuscular tube, around 25cm in length. It carries food from the pharynx (the part of the throat behind the mouth and nasal cavity) to the stomach.  It is lined by pink tissue known as mucosa. The esophagus is in front of the spine and behind the trachea or windpipe and heart. It is made up of muscles that run both circularly and longitudinally while entering the abdominal cavity through the right of the diaphragm at the level of the 10th thoracic vertebrae. It assists or helps in the passing of the food bolus in the stomach. Hence it’s the portion of the digestive system. The UES or the upper esophageal sphincter is a bunch of muscles at the beginning of the esophagus. The muscles of the UES are under voluntary control and are used when eating, breathing, vomiting or belching.  They prevent secretions and food from passing down the windpipe. The LES or the lower esophageal sphincter is a bunch of muscles that are at the bottom of the esophagus, where it meets the stomach. When the LES or the lower esophageal sphincter is closed, it prevents stomach content and acid from going back from the stomach. The muscles of the LES are not under voluntary control. When the food or the liquids are passed on by the peristaltic waves and reaches the sphincters, reflex pathways create the muscles to momentarily relax and open which allows the bolus to pass. At the rest of the time, these sphincters are completely shrunk to stop the reflux of food particles or the gastric acid into the previous section of the digestive tract. The stomach makes gastric acid, which is a strong acidic mixture made up of HCL – hydrochloric acid and sodium and potassium salts to help in food digestion. Restriction of the lower and upper esophageal sphincters helps to stop the backflow or reflux of acid and gastric contents into the esophagus, which protects the esophageal mucosa. Breakdown of any of these two components is the reason for the gastroesophageal reflux and its consequent symptoms and mucosal changes. 

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Frequently asked questions about Esophagus

Which doctors should be approached for any esophagus problems?

A specialist doctor in the field of any disorder or infection of the digestive system is known as the gastroenterologist. It also includes the infection of the stomach, esophagus or food pipe, large intestine, small intestine, liver, pancreas, bile duct, gall bladder, and pancreatic duct. The gastroenterologist will help to analyze any disease or disorder and create a treatment plan accordingly. 

What is GERD and why does it occur?

GERD (gastroesophageal reflux disease) occurs when the acid in the stomach repeatedly flows back into the tube which connects the esophagus and mouth. This acid reflux or the backwash may inflame the lining of the esophagus. This generally takes place due to the relaxed LES or the lower esophageal sphincter or the valve between the stomach and food pipe. Too much intake of carbonated or caffeinated beverages, smoking, and alcohol consumption may lead to gastroesophageal reflux. Other factors are stress, lack of proper sleep, and poor dietary habits. 

What is heartburn and heart ailment?

The most general symptom of GERD (gastroesophageal reflux disease) is acid indigestion or heartburn. It generally feels like a burning chest pain that begins behind the breastbone and moves towards the throat and neck. It gives a feeling like the food is returning in the mouth along with a bitter or an acid taste. The heartburn pain may be around for 2 hours. It becomes worse after eating. Bending or lying down may also cause heartburn. Heartburn pain may be mistaken for a heart attack or a heart disease but there are many differences in both types of pain. Pain caused by heartburn doesn’t usually worsen with any kind of physical activity while the pain due to heart problems usually worsen with exertion. Other symptoms like vomiting, nausea, bad breath, difficulty in swallowing may also be accompanied by heartburn. 

What is the treatment for GERD?

GERD (gastroesophageal reflux disease) can be cured with the help of medication. But if the medications don’t work or when the patient shows critical GERD symptoms, surgery like Fundoplication is one of the options. The surgeon covers up the top of the stomach around the LES or the lower esophageal sphincter to tighten the muscles and to avoid reflux. 

How would the patient know that the esophageal symptoms need treatment?

If the person has constant signs and symptoms, he or she should visit an otolaryngologist – who is a nose, throat, and ear specialist, or gastroenterologist. If the patient experiences difficulty in swallowing, frequent coughing, back or chest pain along with belching, and throat burn kind of symptoms then he or she should visit the doctor immediately. The pain caused by burping or swallowing that spreads out to the back is a cardinal symptom of esophageal problems and the patient should immediately consult a gastroenterologist. 

Which are the disorders of the esophagus?

Many conditions affect the esophagus. The major ones include: 

Achalasia: which is a disorder of the food pipe or the esophagus where the sphincter or the muscle, which is at the base of the pipe and opens into the stomach, does not relax or contract as needed due to the nerve damage or there exists other cause of obstruction. 

Barrett's Esophagus: Frequent reflux of the acid of the stomach inflames the esophagus which may change its structure. 

Esophageal Cancer.

Gastroesophageal Reflux Disease (GERD)

Gastroparesis.

Swallowing Disorders: This includes trouble in swallowing (dysphagia) or pain while swallowing (odynophagia). 

What is endoscopy?

Endoscopy is a type of method wherein a flexible thin tube attached with a camera enters the patient’s body through the mouth. This method is a minimalistic invasive way to detect and treat gastrointestinal diseases. This procedure may be done using local anesthesia or with general anesthesia. 

Name the best gastroenterologist in India?

Dr. (Col) V.K.Sharma

Dr. Amitabh Dutta

Dr. Chandrasekhar Jyothiraj

Dr. Mohit Shetty

Dr. Shubahyu Banerjee

Dr. Manoj Gupta

Which is the best hospital for gastroenterology in India?

Asian Institute of Gastroenterology, Hyderabad.

Apollo Hospitals, Greams Road.

BLK Super Specialty Hospital.

Indraprastha Apollo Hospital, New Delhi.

Manipal Hospital, Bangalore.

Fortis Memorial Research Institute, Gurgaon.

Aster CMI, Hebbal.

Wockhardt Hospitals

Do gastroenterologists do surgery?

These specialist doctors initially detect and treat GI diseases in both women and men. They carry out endoscopic procedures that use special instruments to watch the GI tract and analyze. They do not execute surgery. They would refer the case to the surgeon if any surgery is needed. 

What is the main reason for esophageal cancer?

There is no particular reason but frequent inflammation of the esophagus may lead to the changes which cause esophageal cancer. The role of these risk factors such as smoking, GERD (gastroesophageal reflux disease), Barrett’s esophagus, consumption of alcohol, obesity, bile reflux, trouble in swallowing due to the esophageal sphincter which doesn’t relax – Achalasia, constant drinking of hot liquid, any kind of radiation treatment on the upper abdomen or chest, etc may cause cancer development. 

What are the survival chances of cancer of the esophagus?

The survival rate of patients having cancer in the esophagus is around 47%. The survival rate for patients having infection which has spread to the regional lymph nodes or the surrounding organs or tissues is around 25%. If the infection or cancer has spread to other parts of the body then the survival rate is around 5%. 

How critical is Barrett's esophagus?

Barrett’s esophagus is linked with an increased risk of growing esophageal cancer. Though the risk of growing esophageal cancer is quite small, it’s very important to go for standard checkups with imaging and widespread biopsies of the esophagus to check for dysplasia or the pre-cancerous cells. 

How is esophageal cancer diagnosed?

Diagnosis of esophageal cancer is carried out with a double-contrast barium esophagram. This test shows irregular thinning, ulceration, stiffness of the esophagus, sudden angulations of the esophagus. The Endoscopy process is more sensitive to identify esophageal cancer since it allows direct visualization of the area which is affected and biopsy and/or brush cytology of the affected tissue can be done in an endoscopic procedure. Also, a EUS- endoscopic ultrasound is a technical low-risk process that allows imaging at nearer proximity to identify even the slightest mucosal changes. Screening endoscopy is carried out on patients who face an increased risk of forming esophageal cancer like Barrett’s esophagus. 

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Esophagus Conditions

  • Heartburn: An incompletely closed LES will allow the acidic content of the stomach to reflux in the esophagus. This reflux may lead to cough, heartburn, or no symptoms at all. 
  • Gastroesophageal reflux disease (GERD): When the reflux takes place repeatedly or is troublesome, it is known as gastroesophageal reflux disease. 
  • Esophagitis: Irritation of the esophagus may be due to inflammation or infection. 
  • Barrett's esophagus:  Regular reflux of acid inflames the esophagus which may lead to the change in structure. In rare cases, Barrett’s esophagus leads to esophageal cancer. 
  • Esophageal ulcer: corrosion in the lining of the esophagus which is due to frequent reflux. 
  • Esophageal stricture:  This is a thinning of the esophagus. Frequent irritation due to the reflux is the general root of esophageal strictures. 
  • Achalasia: An uncommon disease in which the LES does not loosen properly. Regurgitation and difficulty in swallowing food are a few of the symptoms. 
  • Esophageal cancer: Though esophageal cancer is not a common type of cancer it’s quite serious. The risk factors are frequent acid reflux, heavy drinking and smoking. 
  • Mallory-Weiss tear: Retching or vomiting makes a tear in the esophagus lining. The esophagus bleeds in the stomach which is followed by blood vomit. 
  • Esophageal varices: People who have cirrhosis, the esophagus veins bulge and swell up. These are known as the varices and these veins are susceptible to severe bleeding. 
  • Esophageal ring (Schatzki's ring):  This is a non-cancerous growth of tissues in a ring at the bottom of the esophagus. Schatzki’s rings do not cause any symptoms but may lead to trouble in swallowing. 
  • Esophageal web: A buildup of tissues that is similar to an esophageal ring generally occurs at the upper part of the esophagus. Similar to the rings even the esophageal web does not cause any symptoms. 
  • Plummer-Vinson syndrome:  This condition includes deficiency of iron – anemia, difficulty in swallowing, esophageal webs.  Treatments include dilation of esophageal webs and iron replacement. 

Most of the disorders of the esophagus may be treated medically, but if the symptoms are critical, surgery may be required. An anti-reflux surgical method known as the Nissen Fundoplication is quite effective to control the symptoms of Barrett’s Esophagus, GERD, Achalasia and Dysplasia (growth of abnormal cells which sometimes precede cancer). 

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