Introduction

Definition of oesophagus issues

Oesophageal issues are a collection of disorders that affect how the oesophagus works. Your oesophagus can also be referred to as your food pipe and is part of your digestive system. It is an organ through which food travels from the pharynx (throat) to the stomach for further digestion.¹

A lot of conditions can affect the oesophagus leading to oesophagus issues that can result in difficulty swallowing. One of the most common disorders is gastrointestinal reflux disease (GORD). 

GORD is a condition where acid from the stomach flows back into the oesophagus (gullet). The weakening of the ring of muscle at the bottom of the oesophagus results in excessive stomach acid moving back into the oesophagus, the condition is referred to as acid reflux and it causes inflammation and heartburn. This is so because the stomach acid persistently flows back into your oesophagus. This results in signs and symptoms such as heartburn, persistent cough, chest pain, hoarseness, bad breath and trouble swallowing.

Importance of early detection and treatment

If left untreated over a long period, oesophagus issues such as GORD can lead to complications that cause significant damage to your oesophagus. For example, Barrett's oesophagus, which is a medical condition where some of the cells in your oesophagus grow abnormally, is a risk factor for oesophageal cancer and it is sometimes called a pre-cancerous condition. It is therefore important to detect oesophagus issues early so you can minimize the chances of developing oesophagus complications.

Moreover, survival rates of people with early stages of oesophageal cancer are higher, implying that early detection improves the chances of survival. It is one of the most unknown and deadliest cancers worldwide. It is extremely aggressive in nature and patients have a poor survival rate. It is the 6th leading cause of death from cancer and the 8th most common cancer in the world. ² Thus making early detection is very important.

Overview of factors that can contribute to oesophagus issues

There are a lot of factors that can contribute to oesophagus issues. 

• Overweight: It increases the pressure on your stomach and weakens the muscles at the bottom of the oesophagus
• Fatty diet: It causes your stomach to take a long time to get rid of stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus 
• Lifestyle: Smoking, alcohol, and excessive consumption of coffee or chocolate relax the muscles at the bottom of the oesophagus and might lead to acid leaking into the oesophagus 
• Stress: It affects the oesophagus contractions which propel food toward the stomach. Irregularity in these contractions can lead to reflux
• Pregnancy: It temporarily changes the hormone levels resulting in the relaxation of the valve which normally prevents the reflux of acid into the oesophagus 
• GORD: It can be caused by increased pressure on your stomach during pregnancy as well as a condition called hiatus hernia which allows a part of your stomach to push up through your diaphragm
• Gastroparesis: It is a condition when the stomach takes longer to get rid of stomach acid meaning excess acid can leak up into the oesophagus 
• Medication: Certain medicines can also act as risk factors as well. These include calcium-channel blockers which are used to treat high blood pressure, nitrates used to treat angina and non-steroidal anti-inflammatory drugs (NSAIDs)

Types

GORD (Gastro oesophageal reflux disease)

GORD is a common condition, where acid from the stomach leaks up into the oesophagus (gullet) significantly impacting an individual's life. It is caused by failure of the sphincter mechanism at the lower end of the oesophagus. Symptoms of GORD can be broadly grouped into those directly related to reflux episodes such as heartburn, regurgitation and water brash, and those caused by complications of reflux disease, including dysphagia and respiratory symptoms.

Barrett's oesophagus

Barrett's oesophagus is a medical condition where some of the cells in your oesophagus are damaged by stomach acid and eventually replaced by cells from the intestines, which then start to grow abnormally. This slightly increases your chances of getting oesophageal cancer. It is sometimes called a pre-cancerous condition. But this is not common. They often have no symptoms. However, you might experience symptoms of indigestion and heartburn.

Oesophagitis

Eosinophilic oesophagitis (EoE), is an allergic reaction in the oesophagus that is caused by the accumulation of eosinophils (white blood cells) in the lining of the oesophagus and looks a bit like eczema of the oesophagus. The eosinophils cause inflammation in the oesophagus, leading to symptoms such as difficulty swallowing, poor weight gain, decreased appetite, chest/abdominal pain, reflux-like symptoms, vomiting and food getting stuck. Food allergies may cause the buildup of eosinophils in your oesophagus as well.

EoE is a chronic disease but can be managed successfully with diet and/or medication, making it not life-threatening. However, it can permanently damage the oesophagus if left untreated.

Other problems 

Other problems affecting the oesophagus are:

• Achalasia
• Oesophageal diverticulum
• Oesophageal varices
• Oesophageal cancer rarely occurs. Adenocarcinoma and squamous cell carcinoma are the two types of oesophageal cancer

Symptoms

• Heartburn: The stomach acid travelling up towards the throat causing a burning feeling in the chest (acid reflux). If it is persistent, it results in GORD.
• Difficulty swallowing:  It may feel like the food is stuck in your throat (dysphagia)
• Chest pain: Pain in any area of your chest that spreads to other areas, including down your arms, and into your neck or jaw. It can be sharp or dull. You may experience aches and tightness or feel your chest being crushed or squeezed.
• Regurgitation: It is a result of acid reflux where acid and other stomach contents are brought back up (regurgitated) into your throat and mouth
• Nausea

Diagnosis

• Physical examination and medical history: Medical professionals will take medical history to see if you have signs and symptoms of oesophagus disorders
• Endoscopy: A flexible tube with a camera on the end (endoscope) will be inserted through your throat via the mouth or the nose and into your oesophagus to examine your oesophagus, stomach and first part of your small intestine (duodenum) looking for abnormal cells. 
• Biopsies: A small tissue sample that is taken to confirm diagnosis and look for abnormal cells (dysplasia). A pathologist will grade the dysplasia into high-grade or low-grade
• Oesophageal manometry: A thin, flexible tube (catheter) that contains pressure sensors is passed through your nose, down your oesophagus and into your stomach. It measures the force and coordination of oesophageal muscles as they move food to your stomach. It also measures contractions that push food into your stomach
• pH monitoring: Your healthcare provider will place a thin tube (catheter) in your oesophagus. This test measures how often stomach acid enters your oesophagus and how long it stays there

Treatment 

Lifestyle modifications

Lifestyle modifications can help treat symptoms of most oesophagus issues. This includes:

• Eating smaller but more frequent meals and avoiding any foods or drinks that trigger your symptoms such as fatty foods, coffee, chocolate, tomatoes, alcohol, and fatty or spicy food
• Avoid eating or drinking or having heavy meals 3 to 4 hours before bed
• Maintaining your body weight
• Elevating the headrest of your bed 
• Avoid wearing tight clothing 
• Manage stress by practising relaxation techniques
• Avoid alcohol or smoking

Medications 

Prescription medicines or over-the-counter medicines can be used to treat oesophagus disorders. They include over-the-counter medications like

• Antacids neutralise the effects of stomach acid
• Alginates produce a coating that protects the stomach and oesophagus (gullet) from stomach acid 

Prescription medicines like 

• H2-receptor antagonists (H2RAs),low-dose proton-pump inhibitors and proton-pump inhibitors (PPIs) reduce the amount of acid your stomach produces

Surgery

Surgery is performed to stop stomach acid leaking into your oesophagus and may be recommended if medication or lifestyle interventions aren't helping. Laparoscopic Nissen fundoplication a surgical procedure(the upper part of the stomach is wrapped and stapled around the lower oesophagus) may be carried out.  

Other procedures

The GP might treat patients with more severe symptoms or oesophagitis with injection therapy or anti-reflux surgery.

Management and prevention

To prevent the complications, it is important to have 

Self care measures

Taking proper self-care measures is important. It includes eating smaller but more frequent meals and avoiding any foods or drinks that trigger your symptoms such as fatty foods, coffee, chocolate, tomatoes, alcohol, and spicy food. Maintain your weight and make sure the head of your bed is kept raised. 

Follow up care

Care for people diagnosed with oesophagus cancer does not end when active treatment is finished. Your healthcare provider will ask you to come for follow-ups to check for recurrence, manage any long-term side effects, and monitor your overall health. 

Follow-up may include regular physical examinations, medical tests, or both. Your GP may recommend cancer rehabilitation in the form of physical therapy, occupational therapy, career counselling, pain management, nutritional planning, and/or emotional counselling to help remain as independent as possible. 

Summary 

Oesophageal issues are a collection of disorders that affect how your oesophagus works. Your oesophagus can also be referred to as your food pipe and is part of your digestive system. It is an organ through which the food travels to reach the stomach for further digestion. Risk factors that increase the chances of oesophageal issues include being overweight, eating food high in fat, consuming too much alcohol and smoking. The symptoms that you might commonly experience include nausea, chest pain, heartburn, difficulty swallowing and regurgitation. You can manage these symptoms by implementing small lifestyle changes and taking over-the-counter medicines. In some cases, stronger prescription medicines, injection therapy or surgery may be required. Please visit your GP if you experience any of these symptoms, as it is important for oesophagus issues to be detected early and treated to minimize the chances of developing oesophagus complications such as Barrett oesophagus, which may lead to oesophagus cancer.