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Posted: Monday, April 20, 2015

Esophageal Disorders and Treatments

The esophagus is one of the basic organs of the human body, responsible for carrying food, liquids and saliva from our mouths to our stomachs. While that function might seem simple enough, the esophagus can be subject to a variety of complex problems, including motility disorders, hernias, acid reflux and esophageal cancer. If you or a loved one has ever experienced any of these disorders, you know how uncomfortable and potentially dangerous they can be. However, there also are ways to treat them.

“One of the most common esophageal disorders is gastroesophageal reflux disease or GERD, which affects up to 100 million Americans,” said Blount Memorial thoracic surgeon Dr. Jason Budde. “It typically is caused by a weakened muscle valve called the lower esophageal sphincter, which would normally keep stomach acid from washing up into the esophagus. This causes heartburn, sore throat, coughing, throat-clearing or even chest pain. Other cases may be picked up by a pulmonologist from coughing, breathlessness, recurrent episodes of pneumonia, or sleep apnea,” he explained. “Patients should report these symptoms to their primary care professional. From there, patients may see an ear-nose-throat specialist or gastroenterologist. Tests may include a dye, or barium, swallow under X-ray, and an endoscopy of the throat, esophagus and/or stomach, usually with a pH probe to detect acid levels. When needed, treatment would begin with antacids such as Zantac or Pepcid, or proton pump inhibitors – also known as PPIs – such as Prevacid or Protonix,” he added.

“PPIs only should be taken for a short time,” Budde said. “If symptoms return, patients should seek testing because erosions in the esophagus, if not addressed, can lead to esophageal cancer – a devastating diagnosis if detected too late. If testing shows a severe case of GERD, stomach surgery – called fundoplication – may be required. The good news is that the procedure is performed using minimally invasive laparoscopy, with one-to-two day hospital stays and usually 95 percent satisfaction rates,” he explained.

Another common esophageal condition is known as hiatal (or paraesophageal) hernia, which may exist with or without reflux. “These hernias occur when the stomach bulges up into the chest,” Budde said. “This can cause reflux symptoms, shortness of breath, chest pain or possibly no symptoms at all. Typically, these hernias are detected on X-rays, computed tomography (CT) scans or other radiology studies. If the hernia is considered large, repair is recommended as soon as possible in order to avoid emergencies within the stomach, some of which can be dangerous and even deadly. Surgical repair of the hernia is almost identical to reflux surgery. If you have a large hiatal hernia, you should seek treatment as soon as possible to avoid big problems,” he explained.

While it’s more common around the world than in the United States, Budde says esophageal cancer currently is increasing faster than all other cancers. “Esophageal cancer rates in the U.S. have risen about sevenfold in the past 30 years,” Budde said. “The major contributing factors are reflux (GERD) and smoking in that order, which is why we ask patients to not ignore their reflux disease, and to quit smoking. When detected early, the prognosis for patients with esophageal cancer is greatly improved, so it’s crucial that patients seek treatment immediately for chest pain or any abnormality with swallowing. The best outcomes, by far, occur when the patient’s cancer stage is early – when the tumor is small and confined to one area – so that an operation will be able to remove the entire tumor. This surgery is known as esophagectomy, and usually is used in conjunction with chemotherapy and radiation. An esophagectomy involves the removal of roughly 75 percent of the esophagus, with connection of the stomach as a new, replacement esophagus. While some patients may require a feeding tube for a period of time, most will recover full eating ability,” he said. “Blount Memorial Hospital and the Blount Memorial Cancer Center employ a team of gastroenterologists, radiologists, surgeons, medical and radiation oncologists, and swallowing experts to safely and effectively treat this serious cancer,” Budde added.

“The key to effective esophageal treatments and cures is for patients to report symptoms promptly and follow up closely with their doctors. Don’t wait until it’s too late,” Budde said.

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