Esophagus Disorders

After you chew and swallow food, it is carried to your stomach through a long, hollow tube called the esophagus. While it’s easy to assume that food simply “falls” down this tube thanks to gravity, the esophagus is actually a complex organ that plays an important role in digestion.

At the top of the esophagus is a specialized muscle called a sphincter, which opens and closes to allow (or prevent) food from entering the esophagus. Once inside the esophagus, food is propelled down toward the stomach via a series of muscle contractions. At the bottom of the esophagus is a second sphincter, which opens and closes to allow food to enter the stomach and to prevent food or stomach acids from leaving the stomach.

For many reasons, including illness, injury and aging, our esophagus may stop working properly. This can lead to a variety of problems, including difficulty swallowing, heartburn and GERD, and even pre-cancerous or cancerous lesions.

Scripps gastroenterologists have extensive experience diagnosing and treating a variety of medical conditions that impact the esophagus, including:

• Achalasia occurs when the sphincter muscle located at the bottom of the esophagus stops working properly, making it difficult for food or liquid to pass into the stomach.

• Gastroesophageal reflux disease, also called GERD or acid reflux, occurs when acid flows backward out of your stomach and into the lower esophagus. Symptoms may include a sour or acidic taste in your mouth, heartburn, chest pain, difficulty swallowing or a hoarse voice.

• Barrett’s esophagus, a condition that usually occurs in people who have had long term GERD. Over time, as stomach acids continue to flow backwards from the stomach up into the esophagus, they can erode the esophageal wall and cause tissue changes. People with Barrett’s esophagus have a higher risk of developing esophageal cancer.

• Eosinophilic gastroenteritis, a rare condition that can be mistaken for a food allergy due to its tendency to cause nausea, vomiting, abdominal pain or diarrhea. People with eosinophilic gastroenteritis have a high level of eosinophils, a type of white blood cell, in their GI tract and in their bloodstream. Sometimes the condition is localized in the esophagus (eosinophilic esophagitis) or in the colon (eosinophilic colitis).

• Esophageal cancer is cancer that occurs in the esophagus, usually in the cells that line the inner wall.

• Swallowing disorders and motility disorders. People who often gag, choke, or have trouble swallowing need specialized care from doctors who can diagnose the root cause and prescribe an effective treatment plan. Learn more about motility disorder care at Scripps.

Scripps physicians can diagnose esophageal disease using one or more of the following tests:

• Endoscopy, a procedure that allows doctors to look inside your body with the aid of a tiny camera attached to a thin, flexible tube called an endoscope. Small instruments or devices can be attached to the endoscope, allowing it to be used for both diagnosis (such as taking a tissue sample) and treatment (for example, to remove tumors).

• High-resolution esophageal manometry is a procedure that measures how the muscles in your esophagus contract and relax after you swallow, which is an indication of how well your esophagus is functioning. The high-resolution system offered at Scripps is the gold standard for diagnosing motility disorders, allowing your gastroenterologist to pinpoint the underlying cause of your symptoms and effectively treat them.

• Endoscopic ultrasound, or EUS, is a procedure that combines endoscopy and ultrasound to capture high quality images of the digestive tract. It is often used to diagnose Barrett’s esophagus and stage esophageal cancer.

• Fiberoptic endoscopic evaluation of swallowing, or FEES, is used to test swallowing function. A camera attached to a catheter is placed in your throat, where it records what happens when you swallow food.

• Modified barium swallow studies are used to evaluate your swallowing ability via an X-ray. During the procedure, you’ll swallow small amounts of food or beverage mixed with a special solution called barium, which is highly visible during an X-ray.

• Esophageal pH testing is used to measure whether acid is escaping the stomach and flowing backward into the esophagus. Scripps offers traditional and wireless pH testing.

  
  

  • During traditional esophageal pH testing, a catheter containing a sensor that detects acid is passed through your nose and down into your esophagus, where it remains for 24 hours.
  • During wireless esophageal pH testing, a small capsule is placed on the wall of your esophagus via a catheter. Once the catheter is removed, the device wirelessly transmits pH measurements to a receiver worn at your waist.

If you’ve been diagnosed with an esophageal disorder, your gastroenterologist will work closely with you to create a treatment plan that will help resolve your symptoms and improve your quality of life.

In addition to prescribing medication or dietary changes, your doctor may recommend one of the following procedures:

• Medication is often used in combination with lifestyle changes to treat GERD symptoms, including heartburn. Your doctor may recommend you first try over-the-counter medications that help control acid. If those don’t work, he or she may prescribe medications called H-2-receptor blockers (which reduce acid production) or proton pump inhibitors (which block acid production and can help heal the esophagus).
• Esophageal balloon dilation is a procedure that allows your doctor to widen a narrowed portion of your esophagus using a special balloon attached to an endoscope. When the balloon inflates, it stretches the portion of the esophagus that has become too narrow.
• Laparoscopic Heller myotomy is a minimally-invasive surgical procedure used to treat achalasia.
• Minimally invasive esophagectomy is a surgical procedure that removes part or all of the esophagus. After it is removed, the esophagus is rebuilt from part of your stomach or part of your large intestine. This procedure is usually reserved for patients who have Barrett’s esophagus or esophageal cancer.
• Cryoablation, also known as cryotherapy, is often used to treat Barrett’s esophagus or early-stage esophageal cancer. During the procedure, a liquid nitrogen spray is used to freeze and kill pre-cancerous or cancerous lesions inside the esophagus.
• Radiofrequency ablation, or RFA therapy, is also used to treat Barrett’s esophagus. It uses thermal (heat) energy to burn and kill pre-cancerous lesions.
• Endoscopic mucosal resection is a procedure that removes abnormal or cancerous tissue from the gastrointestinal tract, including the esophagus, stomach and colon.
• Minimally-invasive fundoplication, or anti-reflux surgery, is a treatment for GERD. It is often used when patients have tried other options, including medication and lifestyle changes, without success.
• Incisionless GERD surgery is also used to treat chronic acid reflux. Scripps offers a procedure called Transoral Incisionless Fundoplication, or TIF. A special device called an EsophyX is attached to an endoscope and guided through the mouth under general anesthesia. It allows surgeons to reinforce a weak esophageal sphincter.
• If you have esophageal cancer, your gastroenterologist will work closely with Scripps cancer specialists to create a customized treatment plan. Learn more about esophageal cancer treatment options at Scripps.

Scripps gastroenterologists offer consultations or care for people with esophagus disorders at the following locations:

• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital (San Diego and Chula Vista)
• Scripps Green Hospital
• Scripps Clinic Carmel Valley
• Scripps Clinic Encinitas
• Scripps Clinic Rancho Bernardo
• Scripps Clinic Rancho San Diego
• Scripps Center for Voice and Swallowing