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Esophagus is an organ referring to the digestive system of the body; it plays an important role in the process of ingesting food. Pathologies in the function of esophagus come shapes as a vast number of various diseases that should better be recognized as early as possible for the best therapeutic outcomes.It is important to tell the signs of esophageal disturbances in their initial stages, as some of them have serious and life-threatening complications.
At the same time, we are all familiar with such esophagus-related phenomenon as heartburn, which is normally associated with a particularly fatty or excessive meal, food allergy or stress – you should not worry too much about such instances. BestHomeRemedies.com gives a full list of esophageal diseases with their symptoms, causes and prognosis.
The esophagus is the food channel tract that joins the pharynx with the mouth of the stomach. This muscular duct extends between the sixth cervical vertebra and the tenth thoracic vertebra, for a total length of 9-10 inches. Its thickness, at the point of greater diameter, reaches 0.09 to 0.1 inches, while in the nearest diameter 0.07 inches. In its functioning course, the esophagus has relationships with numerous anatomical structures, including the trachea, thyroid lobes and the heart, before the spine behind, and the diaphragm, which crosses at a small opening called esophageal hiatus.
The esophagus is comparable to a connection tube – nearly vertical, similar to an elongated S – that allows the food to descend from the mouth to the stomach (anterograde transportation) and vice versa (retrograde during burping and vomiting).
The functions of the esophagus, however, are not limited to simple transporting. Very important, for example, is the lubricating activity, which allows to keep its internal walls moist, facilitating the descent of food. In addition, the esophagus, due to the presence of a sphincter at the extremities, opposes the entry of air into the stomach during breathing and rising gastric contents into the oral cavity.
The passage of the food bolus from the pharynx to the esophagus is regulated by the upper esophageal sphincter. A sphincter is a muscular ring with a tone so accentuated to remain in a state of continuous contraction. This state can be modified for voluntary mechanism (external anal sphincter) or reflex (such as the two sphincters of the esophagus).
The upper esophageal sphincter participates in degenerative function, opening to allow the pharynx to push the bolus into the esophagus. In rest, the muscle that constitutes it is contracted and the sphincter remains closed, preventing the passage of air into the digestive tract and inhaling food into the airways.
As mentioned, the esophagus is provided with a muscular wall consisting of two structures: a longitudinal external muscular layer and a circular interior. The latter is entrusted with the propulsive activity, which allows him to perform very important movements of peristalsis. As a segment of upstream muscle contracts, the downward stretch relaxes. Later this will be contracted and so on, with succession from top to bottom to the full descent of the food bolus in the stomach. Esophageal peristalsis is facilitated by the lubricating action of saliva and esophageal secretions.
When the peristaltic wave invests the lower part of the esophagus, it produces a relaxation of the lower esophageal sphincter (LES) resulting in the inflammation of the bolus in the gastric sac. At this stage, LES regains normal hypertension and prevents gastric uplift in the esophagus. If the lower esophageal sphincter does not have sufficient tone, gastric juices and pepsin may originate from the stomach causing so-called gastroesophageal reflux. This is a common and annoying disorder, since these substances strongly irritate the esophageal mucosa, causing pain and fever (burning sensation).
The internal walls of the esophagus are coated with muscled tuna, a multi-layered epithelium that often protects it from the transit of food (which may have pointed ends or particularly hard residues). Within certain limits, this effective barrier also repairs it by physiological acid reflux, which appears, especially after meals, a bit in all people.
When the LES, normally located beneath the diaphragm, enters the esophageal hiatus up into the chest cavity, it is referred to as a gliding hiatal hernia, an ever-increasing disease especially in people over the age of 45-50. Its symptoms are overlapping but generally stiffer than those of gastroesophageal reflux.
Functions of the esophagus
The esophagus is an organ involved in swallowing, a process of transporting the food bolus from the mouth to the stomach. This movement begins voluntarily (with the help of the tongue, glottis, etc.) and then turns into an involuntary movement. This means that the upper portion of the esophagus has a striated muscle contracted by the subject’s will (such as that of the musculoskeletal system), while the lower esophageal tract is characterized by a smooth muscle (such as that of the stomach and the intestine), therefore involuntary.
Swallowing is based on synchrony and coordination between the larynx, pharynx and esophagus, and occurs in 3 distinct phases:
- Oral, voluntary, when the bolus is pushed from the tongue into the back.
- Pharyngeal phase, involuntary and reflexive, consists in passing food into the esophagus through the pharynx. At this stage the epiglottis is displaced posteriorly and prevents the passage of the bolus in the respiratory tract.
- Esophageal phase, involuntary, promotes the transit of the bolus to the stomach due to the esophageal peristalsis (wave motion, which exfoliates the esophagus from top to bottom). There are two types of esophageal peristalsis: primary or triggered by swallowing and secondary or generated by oesophageal distension).
Esophagus pain causes
It is possible to say that esophageal diseases are secondary to a mild motility of the whole organ.
- Hypermotility diseases, which are determined by increased contractile capacity of the esophagus
- Diseases of hypomotility, which are determined by a less contractile capacity of the esophagus.
These are disorders characterized by the presence of violent and / or uncoordinated muscular contraction of the food bolus (peristaltic waves) and the inability to release the esophageal sphincter.
Achalasia: Disease related to the failure to release the lower esophageal sphincter associated with an absent or incoherent movement of the esophagus. It is frequently caused by the depletion of muscle tone inhibitory neurons, and the most indicative symptom is dysphagia, or the feeling of stopping of the bolus ‘behind the sternum’.
This is a kind of dysphagia called paradox because it involves both the ingestion of liquids and solids, and therefore differs from the progressive dysphagia mainly affecting the liquids. It frequently accompanies the replenishment of food. The diagnosis is made via the manometry that measures both the absence of esophageal muscle movement and the increase in the pressure of the lower esophageal sphincter. The therapies are different: pharmacological (by injection), endoscopic sphincter dilation and surgical.
Nutcracker esophagus and diffuse esophageal spasm: Nutcracker esophagus causes contractions normally coordinated but with average amplitude and duration over the standard, which are strongly painfully felt. Diffuse esophageal spasm is characterized by numerous non-peristaltic (simultaneous, therefore non-propulsion) uncoordinated contractions, which occur after swallowing with angular-like pain. These are esophageal diseases associated with psycho-physical stress conditions, which can be diagnosed by manometric examination and pharmacologically treatable.
Esophageal diverticula: they can be caused genetically or acquired. Those acquired can be caused by gradual estroflexion of the mucosa and subcutaneous as an effect of increased pressure (called acquired) or for scar tract on the esophagus wall (called ‘traction’).
They are esophageal diseases characterized by the ineffectiveness of the lower esophageal sphincter. The main clinical manifestation is gastro-oesophageal reflux (GERD).
Gastro-esophageal reflux disease (GERD): generally asymptomatic esophagus disease that in the long term can compromise the integrity of the mucosa. GERD determines: burning (pyrosis) located in the retrosternal site (due to the acidic action of gastric contents on the esophagus mucosa), regurgitation of acidic material and epigastric pain (cautioned below the sternum). Exams to diagnose GERD are mainly esophagogastroduodenoscopy and PHmetria of the 24h. Cure is mainly due to pharmacological therapy and dietotherapy. If neglected, GERD may complicate and lead to esophagitis or, in the worst case scenario, to Barrett’s esophagus.
Let’s take a closer look at the two groups of the diseases of the esophagus described above.
1. Esophageal achalasia
Esophageal achalasia is a disorder of motility affecting the esophagus. The disease occurs due to the lack of peristalsis and an incomplete opening of the lower esophageal sphincter (muscle valve located between the esophagus and the stomach) during swallowing.
Esophageal achalasia, consequently, makes it difficult to drop the bolus (saliva and food mixed in the mouth during chewing), which happens rather slowly and does not induce the opening of the lower esophageal sphincter . There is therefore an accumulation of food material at the base of the esophagus, which causes further patient ailments (regurgitation and chest pain).
The most common form, primary achalasia, is caused by an anomaly innervation of the smooth muscle of the esophagus, in the absence of other pathological conditions. However, a small percentage of cases occur as a secondary form to other pathologies such as esophageal cancer or Chagas disease. There is no gender predominance and the onset of the disease is manifested mainly in adults between the ages of 20 and 40 of both sexes.
Diagnosis is defined by radiographic examinations with barium and esophageal manometry. Some drugs or botulinum toxin injections may give temporary relief to cases of mild or moderate oesophageal achalasia, while the most effective and lasting intervention involves endoscopic therapy (esophageal dilatation with balloon) or surgical procedures (such as Heller myotomy).
The esophagus is a muscular tube that connects the pharynx to the stomach. Within this hollow organ the transit bolus pushed by peristaltic movements, that is, by rhythmic waves of involuntary muscular contractions. Peristalsis involves contraction of the esophageal tract preceding the bolus (upstream) and the relaxation of the next stroke (downstream), so as to determine the rapid progression of food from the esophagus to the stomach.
The lower esophageal sphincter is a valve interposed between the end of the esophagus and the initial stomach. Has the function of preventing reflux of acidic gastric contents in the esophagus, opening only to allow food to pass during swallowing or vomiting.
Esophageal achalasia is a motor disease characterized by the loss or alteration of peristalsis and the absence of the lower esophageal sphincter when swallowed. Achalasia does not involve the upper esophageal sphincter and pharynx, so the patient can eat and swallow, but the food bolus can easily stop along the esophagus. It is followed by: vomiting of un-digested food, chest pain, stomach burns and weight loss.
Slowly, over a number of years, people with esophageal achalasia experience a growing difficulty in swallowing solid and liquid foods. If it progresses, the disease can cause considerable weight loss, anemia and malnutrition. In addition, with the progression of the pathological condition, the esophagus can deform, stretch or stretch. Patients with achalasia also exhibit a slight increase in the risk of developing cancer of the esophagus, especially if obstruction has been present for a long time. Your doctor may periodically recommend endoscopic controls for the prevention and early diagnosis of esophageal cancer.
Esophagitis is a common condition characterized by inflammation of the esophagus due to excessive ascension of acidic juices from the stomach. In addition to these episodes of gastroesophageal reflux, one of the less frequent causes of esophagitis can include infectious diseases (in immunocompromised patients), ionizing radiation, allergies (eosinophilic esophagitis) and the ingestion of particular drugs or corrosive substances.
Difficulty and pain in swallowing (dysphagia and odyphagia), a feeling that the food tends to go down the esophagus, episodes of retrosternal chest pain, nausea, vomiting, stomach pain, salivary regurgitation, and appetite lossare the symptoms of esophagitis. Contact your doctor straight away if these symptoms are particularly severe, do not resolve with common antacid antacids (such as bicarbonate sodium) or associate with those that are typical of an influenza (fever, headache, and muscle aches).
3. Gastroesophageal reflux (GERD)
Gastroesophageal reflux, or GERD, is the phenomenon of ascension in the esophagus of the stomach contents. Content that has a typical acidic nature. The phenomenon of gastroesophageal reflux occasionally affects many people, often without their knowledge and without pathological origin.
Gastroesophageal reflux is the abnormal ascension of the stomach acid content in the esophagus. This phenomenon can be sporadic or chronic. When it comes to the outline of a chronic problem, doctors speak more about gastroesophageal reflux disease. Chronic gastroesophageal reflux is caused by the LES dysfunction, i.e. the valve located between the esophageal and the stomach, which prevents the rising of the food in the stomach.
Among conditions favoring the onset of gastroesophageal reflux disease include obesity, cigarette smoking, alcoholism, pregnancy, hysterectomy, asthma, excessive consumption of fatty foods, constants use of certain medicines (e.g. anxiolytics, anticholinergics, etc.), stress and gastroparesis.
Typical symptoms of gastroesophageal reflux disease include: stomach burns, chronic acid regurgitation, sore throat, rhinitis, chest pain, dysphagia, alopecia, cough and wheezing.
Generally, the diagnosis of this widespread condition is based on the objective examination and the history. However, under some circumstances, deeper testing, such as gastroscopy and / or 24-hour oesophageal pH measurement, are fundamental. As a rule, therapy is pharmacological. However, if the drugs do not work, there is a possibility of using a surgical treatment. A healthy lifestyle (e.g. not smoking or not consuming too fat foods) helps to control the symptoms.
Gastroesophageal reflux becomes a disease when it leaves the skin of sporadic phenomenon and takes the contours of a chronic disorder, whose recurrence involves the appearance of symptoms and signs, sometimes very annoying. Doctors define the chronicization of gastroesophageal reflux as ‘gastroesophageal reflux disease’ or ‘gastric reflux disease’.
According to statistics, in the so-called Western World, the phenomenon of gastroesophageal reflux is responsible for symptoms weekly with at least 20-30% of the general population. Studies in the age of most patients with gastroesophageal reflux disease have shown that the latter is more common among older people. From these same studies it has also emerged that the number of people with symptoms attributable to gastroesophageal reflux progressively increases from the age of 40. There is no evidence that women or women tend to suffer from gastroesophageal reflux disease. Therefore, it is impossible to assert that male gender is more affected by the female gender, and vice versa.
According to some global surveys, the phenomenon of gastroesophageal reflux would produce symptoms with a weekly / daily rate in 5-7% of the total population. In the US, 20% of the population complains of symptoms attributable to gastroesophageal reflux disease at least once a week, and 7% at least once a day. In countries of the so-called Western World, 50% of gastroesophageal reflux disease diagnoses concern people aged 45-64. In the United States, about 1% of people diagnosed with gastroesophageal reflux disease also suffer from Barrett’s esophagus, a serious complication of the disease. In the United States, there are about 68 million annual pharmacological prescriptions for the treatment of gastroesophageal reflux disease. In 2004, in the United States, 1,150 of total deaths were directly related to the phenomenon of gastroesophageal reflux disease.
The causes of gastroesophageal reflux may be different. We have already said that the problem lies in the incontinence of the valve that separates the stomach from the esophagus, which, when it does not close properly, leaves trace of gastric contents. The reasons why the valve does not close as it should should be numerous. Among the most important are recruitment of some drugs, irritable colon syndrome or the presence of a hysterectomy.
Even pregnancy, obesity, stress, cigarette smoking, and prolonged stay of food in the stomach may favor the onset of symptoms. Other possible causes are attributable to unhealthy eating habits and unhealthy lifestyles, such as falling asleep immediately after meals or eating habit in a hurry and chewing poorly. As we have already pointed out, gastroesophageal reflux tends to occur randomly in all people, especially in infants and the elderly, and we normally do not even notice it.
Other times, however, reflux becomes so frequent and annoying that it becomes a real pathology, so much so that it is referred to gastroesophageal reflux disease. In such a case, it is best to contact a physician who can give you directions. Unfortunately, just because acidity disorders are common among the population, the patient often visits the doctor only after years of living with the disease. This is obviously a wrong behavior, since underestimating the alarm bells can cause serious complications.
The characteristic symptoms of gastroesophageal reflux are pyrosis and regurgitation. The pyrosis is nothing but an annoying burning sensation at the retrosternal level, while regurgitation is the return to the throat or in the mouth of the acidic material contained in the stomach. Chest pain and excessive salivation are also very common. In addition to these frequent symptoms, there may be other less common, called atypical, which include difficulty swallowing, nausea, vomiting, gastric swelling, hiccups, respiratory disturbances with chronic cough, rhinitis, laryngitis, and even asthma.
Symptoms may occur continuously during the day or intermittently. For example, reflux may occur on awakening after meals and at night or only appear in a lying position and as you bend forward, for example, while you are wearing your shoes. Obviously, these symptoms, besides compromising health, have a great impact on the quality of life, while also negatively affecting night-time rest.
Regarding the complications we have repeatedly mentioned, if gastroesophageal reflux disease cannot be treated properly, it may damage the esophagus mucosa causing esophagitis, ulceration, bleeding and stenosis. In addition, repeated acid insults can cause cellular alterations of the esophagus leading to precancerous lesions, including Barrett’s esophagus.
Although the frequent presence of burning behind the chest and acid regurgitation clearly indicates the presence of reflux, it is still necessary to undergo examinations to confirm the diagnosis. Various instrument options are available. Let’s see together the main ones. Among the examinations that contribute to the reliable diagnosis of reflux disease, we mention, for example, the measurement of esophageal pH.
The method involves the introduction of a thin tube which, passing through the nose, is brought to the level of the ‘esophagus-stomach passage’. The probe is then connected to a ‘recorder’ capable of analyzing acidity variations over a period of 24 hours, both in the esophageal and in the pharyngeal laryngeal. The pH meter allows you to measure the number of reflux episodes, the amount of reflux material, the possible correlation with the patient’s position and the intake of the food.
The most common and well-known examination, however, remains the esophagus-gastric endoscopy, called simply gastroscopy, based on the use of a flexible instrument introduced by the mouth. The examination allows diagnosis of esophagitis due to pathological reflux. In other words, the study indicates the presence of an inflammation of the esophageal mucosa and the possible existence of other concomitant pathologies, such as hysterectomy, gastritis, ulcer and neoplasms.
In addition to allowing visual inspection of these organs, gastroscopy also allows the removal of small fragments of mucosa to be subjected to histological examination. Another available survey is gastroesophageal manometry, useful in assessing whether there is anomaly of the motility of the esophagus and LES continence. The radiological examination of the first digestive tract, however, is especially indicated when anatomic malformation is suspected, as in the case of, for example, a narrowing of the esophageal lumen, hiatal hernia or other obstructive lesions.
Medical therapy of gastroesophageal reflux mainly uses drugs that can cope with gastric acid secretion. In this regard, proton pump inhibitors, such as omeprazole or pantoprazole, or histamine H2 receptor antagonists, such as famotidine and ranitidine, are expected to be used. Other particularly useful drugs are so-called procinetics, which act by accelerating gastric emptying.
Thus preventing reflux and stimulating the motility of the digestive tract. A lesser role than the past has antacids, which neutralize acid in the stomach, without however guaranteeing a significant therapeutic result. These drugs may however be associated with other therapies as a symptomatic remedy. Finally, in rare cases, surgery may be indicated to prevent reflux. This ‘extreme’ measure is reserved for patients who are not responding to medications and who have contemporary anatomical problems such as severe erection.
Before thinking of drugs, and in any case in association with them, it is crucial to implement specific eating and behavioral measures that can alleviate the symptoms of gastroesophageal reflux. As for nutrition, meals should be easy to digest and not too copious.
Foods rich in fat, such as many sausages, and fries, which delay gastric emptying, should be minimized. In addition, some foods that can worsen acidity, such as chocolate, coffee, alcohol, mint, spicy dresses and vinegar and lemon-based foods are absolutely avoided. It is then necessary to limit the intake of citrus fruits and tomatoes and their juices.
A precious advice is clearly to eat slowly, chewing each bite well, possibly in a relaxing environment. It is also advisable to avoid taking the horizontal position immediately after eating. Instead of lying down, it should wait at least 2-3 hours. In addition to this, if an overweight condition is present, it is important to gradually reduce the abdominal weight and circumference by using a slightly hypocaloric diet associated with motor activity. Another useful preventive measure is definitely to quit smoking.
Smoking, in fact, facilitates the release of the esophageal sphincter, promoting reflux. To improve symptoms of gastroesophageal reflux and sleep quality, you can also lift the bed headboard by about 6 inches so that you sleep with your head and bust slightly raised. Avoid avoiding too much pillows of pillows that would increase intra-abdominal pressure. As a last tip, it is important to relinquish belts or garments that are too tight in life because they tend to increase abdominal pressure.
4. Biliary reflux
Biliary reflux consists of bile uptake in the upper digestive tract, particularly in the stomach and, in some cases, even in the esophagus. The bile is a digestive fluid produced by the liver and concentrated in the gallbladder, which spills it after meals in the initial intestinal tract, called duodenum.
Bile reflux is caused by the malfunction of the valves between the stomach and duodenum and between the esophagus and the stomach. Excessive presence of bile irritates and inflames gastric and esophageal mucous membranes. The major symptoms resulting from it are pain in the upper abdomen, stomach burning and vomiting containing a yellow-green substance. For proper diagnosis, several tests are required, including gastroscopy. Treatment is usually of a pharmacological nature, while surgery is only used in special cases.
Biliary reflux is thus a rise of bile from the duodenum to the stomach and, in the most severe cases, also to the esophagus. The persistent presence of bile in the stomach and esophagus irritates and inflames the mucosa of these two organs.
To better understand this condition, let’s look closer at its anatomy. The duodenum is the first stretch of the small intestine (or small intestine). Separated from the stomach by means of a regulating valve called pylorus, the duodenum is a key collection point for enzymes and digestive liquids (such as bile and pancreatic juice) that must intervene on ingested food. Bile is a yellow-green aqueous solution, produced by the liver and kept in the gallbladder (or gall bladder).
Composed of water (95%), electrolytes, lipids (bile acids, cholesterol and phospholipids), proteins and pigments (bilirubin), bile has various functions:
- It allows the digestion and absorption of fat and liposoluble vitamins into the diet (main function)
- Neutralizes the acidity of the gastric secretions
- Stimulates intestinal peristalsis
- Eliminates products resulting from the degradation of red blood cells
- Eliminates toxic, pharmacological or endogenous substances (thyroid hormones, estrogens, etc.) in the body
After a fat-containing meal, the bile leaves the gall bladder and first goes through the cystic duct and then the common biliary duct. The latter is connected to the duodenum and allows the bile to flow from the inside.
Gastroesophageal reflux is the uptake of gastric juices (i.e., produced by the stomach) to the esophagus. The gastric juices have an acid pH and this explains why it is also referred to as acid reflux. Biliary reflux and gastroesophageal reflux are two different pathological conditions, although the symptoms are very similar and often indistinguishable. It is also uncommon for both types of reflux to exist in the same individual.
5. Esophagus tumor
Esophageal cancer is a neoplastic process that originates from the esophagus tissues (the channel through which foods and ingested liquids arrive at the stomach). The two main forms of disease are squamous cell carcinoma and adenocarcinoma, resulting from the uncontrolled growth of the internal lining of the esophagus and of the glandular component of the mucous membrane. The main factors that predispose to the onset of esophageal cancer include chronic alcohol ingestion, tobacco use, achalasia, gastroesophageal acid reflux and / or Barrett’s esophagus.
At onset, esophageal cancer manifests itself with swallowing problems: usually, the difficulties appear gradually, first for solid foods and, subsequently, for the liquid ones. Other symptoms include progressive weight loss, reflux, chest pain and rheumatoid arthritis. Over time, esophageal cancer can grow, invade neighboring tissues, and spread to other parts of the body.
Diagnosis is established with endoscopy, followed by computerized tomography (TC) and endoscopic staging. The treatment varies according to the stage of esophageal cancer and, in general, consists of surgery, whether or not associated with chemotherapy and / or radiotherapy. Long-term survival is poor, except in cases involving a localized disease. Stomach burns, acid regurgitation, difficult digestion. These could be the signs of a hysterectomy. Let’s see together what it is.
6. Hiatal hernia
In medical language we talk of hernia whenever an organ, or tissue, escapes from the body cavity that hosts it. Specifically, in the case of hysterectomy, a part of the stomach extends from the abdomen and goes inside the chest which is separated from the abdomen by the diaphragm muscle. Therefore, the portion of the stomach has to go through the diaphragm and it does so in a very precise point called the esophageal lax. Before we move on, we see these concepts clearer through a short anatomical recall. As we have said, under normal conditions, the stomach is in the abdomen.
Abdominal upper is separated from the chest by a muscle, diaphragm. It is a large muscle, flat and wide, similar to a dome, which allows breathing. In the diaphragm there are several openings that allow the passage to vessels, nerves and other structures that from the chest cavity lead to that abdominal and vice versa. One of these openings, called esophageal hiatus, allows the passage of the esophagus. The walls of the esophageal skeleton are particularly tight and adherent to the esophagus, just to prevent the sliding of the stomach inside the chest. Sometimes, however, it may happen that the lax finishes to relax or dilate, leaving a more or less wide portion of the stomach. This is how the hernia appears, which can accompany various disorders, first of all a strong burning sensation at the mouth of the stomach.
The various forms of hernia can be distinguished in three main types: sliding hernia, rotary hernia and mixed hernia. The first, that is the sliding hernia, is surely the most common. Diffused mainly among obese or overweight people, it is present in about 90% of cases. In the snooping hernia, the part of the stomach that rises in the chest is that of the passage between the esophagus and the stomach.
This border region is called gastro-oesophageal junction or LES. Once the LES goes upwards, as it is no longer compressed by the hiatus and undergoes misalignment with respect to the natural position, it loses its function. As a result, LES is no longer able to effectively prevent elevation of the stomach acid content in the esophagus. Thus, the famous gastro-esophageal reflux occurs.
The second type of hiatal hernia, that of rotation or paraesophageal hernia is more rare, but also more dangerous. In this case, the stomach and the esophagus remain firm in their natural positions, while the bottom of the stomach, i.e. the upper part of the organ, rolls upwards into the chest. In these cases the LES remains below the diaphragm and continues to function regularly.
Gastroesophageal reflux is therefore absent, but there are other more awkward complications. For example, stomach blood supply may be compromised, whereas if the herniated portion is very large it may even squeeze the heart and the lungs. The third and final case is that of mixed hernia, a type of hybrid hernia which, as can be predicted by the name, presents the characteristics of both of the forms previously described.
As for the causes, we can observe that hiatal hernia often comes along with age and obesity. In fact, natural aging processes lose tone and elasticity to tissues, including those of the diaphragm. It is no coincidence that the hernia is more common among the elderly. However, the weakness of esophageal hiatus can also depend on a congenital problem, i.e. present since birth.
We should also not forget that even the increase in abdominal pressure favors the onset of hyaluronium. For this reason, women are at risk in pregnancy, overweight persons, chronic obesity sufferers or those who undergo severe abdominal trauma. Finally, they can predispose to the appearance of a hysterectomy even smoking, prolonged physical exertion, and the use of too tight garments.
Some people may suffer from hiatal hernia without experiencing any symptoms or discomfort. In other cases, hernia may cause more or less serious disorders, especially related to gastroesophageal reflux. The rising of stomach acid juices causes irritation of the esophagus mucosa, causing pain and burns behind the stomach and the ‘mouth of the stomach’.
Reflux also accompanies acid regurgitation, intense salivation, rash, nausea, and sudden tachycardia episodes. All of these symptoms tend to worsen during physical exertion, especially when full stomachs, or when you lie down or bend, for example to tie a shoe. An untreated old reflux may cause narrowing and bleeding of the esophagus, increasing the risk of esophageal cancer.
To diagnose hiatal hernia, doctors use mainly two examinations, which are the radiography of the upper gastrointestinal tract and gastroscopy. Radiography is performed after ingesting a barium contrast medium. In this way it can clearly highlight the esophagus, stomach, and the upper part of the small intestine. Gastroscopy, on the other hand, is an endoscopic examination involving the use of a thin flexible hose, at the top of which a camera is placed. This special instrument is inserted into the mouth and dropped down to the esophagus and stomach. In this way, gastroscopy allows you to visually appreciate the hysterectomy and any damage caused by gastroesophageal reflux.
Hiatal hernia is anatomical alteration. Being such can only be corrected by surgery. Drugs, in fact, may be helpful in relieving symptoms and disorders, but of course they cannot reposition the stomach in its natural environment. Particularly useful are all those drugs that reduce the acid secretion of the stomach, allowing the esophagus mucous to regenerate. This is the case, for example, of omeprazole, lansoprazole or other proton pump inhibitors. In association with these drugs, prokinetic agents may also be prescribed to accelerate gastric emptying. As far as surgery is concerned, this is mostly performed in laparoscopy. It is a mini-invasive technique that involves inserting micro-cameras and thin surgical instruments through five or six small incisions carried out on the abdomen. This way the surgeon can reposition the stomach part of the spill and rebuild or restrict the esophageal fever to prevent new hernia.
In association with drugs or while waiting for surgery, diet and some behavioral rules always play a prominent role. First, it is important to avoid foods that increase the acidity and reflux of acids in the esophagus, such as coffee, chocolate, fatty foods and alcohol. It has also been found that obesity and overweight are conditions that increase the pressure on the abdomen. Therefore, it is advisable to undergo a balanced diet and avoid large abusers. Otherwise, adherent clothing or belts should be avoided, while after a meal you should leave at least 2 or 3 hours before bedtime or heavy work. Smoking should also be quitted.
7. Esophageal diverticula
Esophageal diverticula are extroflections in form of a pouch, similar to sacs or pockets, which form in the esophagus wall. The causes that cause it include onset of pressure within the esophagus, weaknesses of its wall, and cicatricial phenomena with periesophageal tissue (surrounding the esophagus).
Bolus trapped inside these pockets (diverticula) may result in regurgitation episodes and may be associated with complications such as inflammation and / or perforation of the internal organs. Diverticula may form at any level of the esophagus, but they mainly involve the distal portion of the cervical and thoracic tract. The most frequent diverticular manifestation of the esophagus is the Zenker diverticulum.
There are several ways to classify the diverticula of the esophagus. First of all, they can be congenital (present at birth) or acquired (they can be developed over the course of life). Congenital esophageal diverticula often results from excessive weakness of the esophageal wall, while acquired shapes are distinct in drive or traction diverticula.
From a histopathological point of view, we can distinguish:
- True diverticula: they affect all layers of the esophageal wall (mucosal, submucosal, muscular and adventitic).
- False diverticitis, also known as pseudo-diverticulitis: they originate from mucous and submucosal healing when a resistance defect in the muscular wall occurs (e.g. Zenker’s diverticulum).
Depending on the location, we can distinguish:
- Hypopharyngeal or cervical or pharyngeal esophageal diverticitis (upper third of the esophagus)
- Peripheral or mediothoracic diverticulas (mid-section III)
- Epiphrenic diverticitis (lower IIIth section)
8. Barrett’s Esophagus
Specialists refer to Barrett’s esophagus when the normal tissue surrounding this muscle duct, located between the pharynx and the mouth of the stomach, is replaced by an epithelium similar to that which internally covers the duodenum walls (initial intestinal tract). To describe this cellular modification physicians simply talk about metaplasia of the esophageal epithelium. In order to be able to speak of all the effects of Barret’s esophagus, however, metaplasia must be evidenced both endoscopically (via a tube provided with a camera dropped down the esophagus) and histologically (by taking endoscopic small tissue samples to be examined via an optical microscope).
Barrett’s esophagus is a typical complication of gastroesophageal reflux. Following the relaxation of the sphincter that virtually separates the esophagus from the stomach (called cardias), the rise of gastric juice in the esophagus determines – in the long run – a modification of the esophageal epithelium, thus attempting to defend itself from the acid. Epithelial cells therefore have very similar characteristics to gastric or duodenal conditions, characterizing the condition known as Barrett’s esophagus. Such complication is considered pre-cancerous, as abnormal epithelium may be due to uncontrolled replication (cancer).
Barrett‘s esophagus is found in 15-20% of patients with chronic gastroesophageal reflux disease (GERD), especially in Caucasian men and older than or equal to 50 years. According to recent epidemiological studies, the risk of developing an adenocarcinoma in the presence of Barrett’s esophagus is estimated at 0.4-0.5% per year per patient, while the 5-year survival rate from the diagnosis of adenocarcinoma (esophagus cancer) is very low (less than 10%). In the light of these data, although the risk is somewhat modest, it is desirable to carry out an endoscopic examination in all patients with reflux, in order to exclude Barrett’s esophagus with certainty.
Barrett’s esophagus is an asymptomatic condition, but it often accompanies the typical symptoms of the reflux disease that caused it (acid regurgitation, pyrosis, difficulty swallowing foods, and dolor-astrostal; in the most severe cases black and tarry stools, and traces of blood in the vomit). The severity of Barrett’s esophagus does not depend much on the symptoms and related disorders, but from its potential evolution to adenocarcinoma (esophagus tumor).
9. Esophageal varices
Esophageal varices are abnormal, circumscribed and usually multiple dilatations of submucosal veins of the esophagus, particularly of its lower third. Typical consequence of portal hypertension, esophageal varices have a congenital origin only in a small percentage of cases. More often, are known to embody one of the most fearsome complications of liver cirrhosis. If not properly treated, esophageal varices can break, resulting in very serious bleeding, fatal in one patient out of five.
Understanding the pathogenesis of esophageal varices cannot ignore the profound knowledge of the anatomy of the venous system of the body. By simplifying the concepts, remember that the vein port has the task of transporting blood from the spleen, pancreas, and intestines to the liver. When the bloodstream of the liver is compromised and the blood struggles to flow inside and out – spilling into the overpaced veins (whose task is to bring it back to the heart through the inferior vein vein) – the pressure inside the vein leads increases.
In this case, we speak of portal hypertension. If we imagine a rubber tube to water and compare it to the vein door, then in the presence of portal hypertension we should think of a cap that prevents the water from flowing out of the tube: if we do not close the tap in time, the water pressure in the pipe will wipe the walls until it explodes.
Fortunately, nature has provided the human body with defensive mechanisms to avoid the tragic breakup of its vessels; once again, we have to use the imagination to compare the circulatory system to a trapped net of vases, similar to the disordered meshes of a net: if the blood flow along a vessel is obstructed or excessively increases the amount of the circulated blood, there are side paths that can bypass the obstacle.
Thus, in the presence of portal hypertension, the vein access is paralyzed by the blood circulation in other vein branches, which ensure its return to the heart. In order to fulfil this function, the side-by-side circles tend to adapt to accommodate the greatest amount of blood pervading them. In particular, at the level of the gastroesophageal junction, submucosal veins intensify until they become true varicose dilations: the esophageal varices. A similar situation occurs in the hemorrhoid area, with the formation of anorectal varices, better known as hemorrhoids.
Esophageal varices occur with difficulty swallowing (dysphagia), but the most characteristic and dangerous sign is bleeding, indicated by blood delivery through vomiting (hematemesis) or through feces (melena: blood, digested, it has a tarry consistency). It is presumed that the rupture of the esophageal varices is the consequence of the rise of gastric juices along the esophagus (regurgitation or reflux), whose acidity erodes the oesophageal mucosa.
Typical symptoms of the esophagus varices are those of the underlying disease, such as those from cirrhosis (jaundice, vomiting, liver pain, edema, splenomegaly, ascites).