Section 9. Digestive Disorders

Chapter 120. Disorders of the Esophagus

Topics: Introduction | Obstruction of the Esophagus | Abnormal Propulsion of Food | Injury to the Esophagus

Obstruction of the Esophagus

The esophagus can be narrowed or completely blocked. In rare cases, the cause is hereditary (for example, congenital rings). In most cases, the cause is progression of an injury to the esophagus or tumor growth. Food and foreign bodies may obstruct the esophagus as well. Injuries that can progress to obstruction can result from damage caused by the repeated backflow of acid from the stomach (gastroesophageal reflux), usually over years. Injury can also result from damage caused by drugs taken in pill form or ingestion of corrosive substances (see Section 9, Chapter 120). Narrowing may also be caused by compression against the outside of the esophagus. Compression can result from a number of causes, such as enlargement of the left atrium of the heart, an aortic aneurysm, an abnormally formed artery (dysphagia lusoria), an abnormal thyroid gland, a bony outgrowth from the spine, or cancer--most commonly lung cancer. Another serious cause of narrowing is noncancerous (benign) and cancerous (malignant) tumors of the esophagus.

Because all these conditions decrease the diameter of the esophagus, people with one of them usually have difficulty swallowing solid foods--particularly meat and bread. Difficulty in swallowing liquids develops much later, if at all.

A barium x-ray is usually taken to find the cause and location of the narrowing or obstruction. Treatment and outcome depend on the cause.

Lower Esophageal Ring

A lower esophageal ring (Schatzki's ring), which results from chronic acid injury, narrows the lower esophagus.

Normally, the lower esophagus has a diameter of 1½ to 2 inches. However, it may be narrowed to ½ inch or less by a ring of tight tissue, which may cause difficulty in swallowing solids. This symptom can begin at any age but usually does not begin until after age 25, because it takes time for acid injury to cause a ring to form. The swallowing difficulty comes and goes and is especially aggravated by meat and dry bread. Often, barium x-rays are taken to detect the problem.

Chewing food thoroughly followed by sips of water usually prevents symptoms. A doctor may fix the narrowing by passing an endoscope (a flexible viewing tube with attachments) through the mouth and throat and into the esophagus or may use a dilator (called a bougie) to widen the passageway. In rare cases, the constricting ring is opened surgically.

Esophageal Webs

Esophageal webs (Plummer-Vinson syndrome, sideropenic dysphagia) are thin membranes that grow across the inside of the upper one third of the esophagus from its surface lining (mucosa).

Although rare, esophageal webs occur most often in people who have untreated severe iron deficiency anemia. The means by which anemia leads to the development of webs is unknown. Webs in the upper esophagus usually make swallowing solids difficult. A cineradiograph (an x-ray that produces a moving image as a person swallows barium) is usually the best procedure with which to diagnose the problem.

Once the iron deficiency has been treated, the web usually disappears. If not, a doctor can rupture it using a dilator or an endoscope.