Diseases of the esophagus: causes, symptoms, diagnosis and treatment

Esophagitis, or inflammation of the esophagus, is an infection of the lining of the esophagus and is characterized by symptoms of severe chest pain, excessive saliva production, and trouble swallowing food.

This inflammatory process occurs for various reasons, but most often due to local irritants, such as probing, frequent, prolonged vomiting, heartburn, burns with alkalis or acids, as well as frequent ingestion of too hot or cold foods.

Important: Inflammation of the esophagus may also have an infectious underlying cause. That is why it is important to identify the source of the problem and only then undergo treatment.

The disease very often develops into a complicated form, and therefore it is worth paying attention to suspicious symptoms in time and contacting the clinic for diagnosis and further treatment.

Important: Complications that may occur as a result of esophagitis include ulcers, Barrett's disease, perforation of the esophageal walls and stenosis.

Diagnostics should consist of:

• esophagoscopy;
• radiography of the esophagus;
• endoscopic biopsy.

Your doctor may also prescribe other research methods.

Causes of esophageal diseases

Problems with the esophagus can occur for a variety of reasons. They can be divided into:

• chemical;
• mechanical;
• thermal;
• infectious;
• congenital.

Chemicals include the consumption of sour, salty, spicy foods, as well as prolonged use of certain medications. Mechanical injuries include various injuries caused by swallowed objects, which could be, for example, fish bones. In addition, poorly chewed food and frequent malnutrition have a negative effect on the esophagus.

Infectious diseases include infectious diseases after which the body has not been fully restored. Congenital causes are associated with pathologies that occur during pregnancy. They can be caused by a difficult pregnancy, genetic abnormalities, or maternal illnesses.

Prevention and risk factors

When analyzing pathology, one must keep in mind that there are a number of risk factors that increase the likelihood of developing those diseases that, in turn, lead to symptoms of esophageal reflux and, accordingly, esophagitis.

Understanding these risk factors can be helpful for prevention. These are habits and lifestyle, a lack or excess of events and specific situations that weaken the body and expose it to greater danger. Analyzing the presented factors, you can see that most of them can be prevented, which means avoiding the occurrence of esophageal disease:

• Obesity. As weight increases, compression in the abdomen increases, and high cardiac pressure can cause reflux.
• Pregnancy. The increasing size of the uterus compresses the diaphragm and cardiac region and therefore increases the possibility of reflux and inflammation of the esophagus.
• Bad eating habits. Eating too much and not chewing thoroughly enough, foods that are too sour and too fatty, and excessive consumption of chocolate are all additional risk factors.
• Lack of movement and sports activity.
• Intense effort. Gastroesophageal reflux can be caused by physical strain on the muscles, so we must be careful, for example, during exercise, such as in the fitness center and when lifting weights.
• Alcohol abuse. Alcohol really has a detrimental effect on the gastric mucosa and causes inflammation.
• Smoking cigarettes. Smoking, among other “side” effects, increases the risk of developing peptic esophagitis and significantly increases the acidity of the stomach, which makes the gastric mucosa extremely sensitive to the formation of erosions under the influence of acids.
• Belts and too-tight clothing put continuous pressure on the abdominal area, favoring reflux.
• Sleep immediately after lunch or dinner.
• Psychological problems: stress, excessive anxiety, panic attacks or depression.

Major diseases

Diseases of the esophagus can occur in people of any age. They can be triggered by various reasons. It is worth noting that in case of untimely treatment, various complications can develop, which leads to the death of the patient. Among the main diseases it is necessary to highlight the following:

• esophagitis;
• injury to the esophagus;
• narrowing of the esophagus;
• dysfunction;
• neoplasms.

Esophagitis can occur in cases of chronic mechanical or chemical irritation from stomach contents. As a result, reflux esophagitis develops, in which not only inflammation of the mucous membrane is observed, but also the formation of ulcers on it. With long-term pathologies, the epithelium of the esophagus is replaced by connective tissue. This inflammatory process can lead to the formation of cancer, so constant monitoring and tracking of dynamics is required.

Injury to the esophagus can vary in severity. Violation of its integrity is accompanied by the occurrence of infectious complications and can lead to the death of the patient. A burn of the esophagus, which manifests itself in the form of pain and burning, is very dangerous. Such an injury can lead to normal cells being replaced by connective tissue, and internal bleeding may also occur when the affected mucosa is injured. Often, surgery is required to restore the integrity of the esophagus or its prosthetics.

Narrowing of the esophagus can be a complication of various diseases. Reducing its diameter causes a lot of inconvenience and leads to a decrease in the patient’s quality of life, since almost any food gets stuck in the narrowing area.

Neoplasms mainly arise against the background of existing diseases. Symptoms are not always well defined, so a comprehensive examination is required to make a correct diagnosis.

Common diseases of the esophageal canal

Pathologies of the esophageal tube have different causes and clinical signs. They arise as their own diseases or are part of a syndrome of other lesions of the body. Among all the ailments of the upper digestive system, the most common are the following.

Ectopia

Ectopy refers to the replacement of the typical esophageal mucosa with secretory tissue of the gastric type. Changes occur in the lower third of the esophageal tube, as if the stomach is growing into the esophagus. Constant irritation of the esophageal mucosa by acidic gastric secretions leads to esophageal inflammation.

Achalasia cardia

An abnormal narrowing of the digestive canal at its junction with the stomach is called achalasia cardia. The lower esophageal sphincter or cardia is a muscular ring that closes the stomach and prevents its contents from exiting. Violation of the sphincter of this muscle, its spasm prevents the passage of food into the stomach. As a result, food accumulates in the esophageal cavity, stretching and irritating its walls.

Esophageal diverticula

Esophageal diverticula occur when the muscular lining of the organ is weak. The mucous and submucosal layer protrudes through the holes in the muscles. Such pouches are formed from inflammation of the esophageal walls. Food accumulates in the diverticula, which leads to rupture of the sac with bleeding and the formation of a fistula. Cervical protrusions are determined by the enlargement of the neck on the side of the diverticulum. The patient coughs, sneezes, and there is a putrid odor coming from his mouth.

Esophagitis

With esophagitis, an inflammatory change in the mucous membrane is observed. Caused by injury, infection, autoimmune process. The most common form is reflux esophagitis. Occurs in children and adults. The patient feels a burning pain in the chest area. The widespread occurrence of reflux is due to the consumption of spicy, fatty, pickled, salty foods. Heartburn provocateurs are coffee, chocolate, citrus fruits, mint, tomatoes, soda, smoked meats. These foods and drinks relax the cardia muscles. The acid-soaked food bolus penetrates back into the esophageal tube and causes a chemical burn.

Hiatal hernia

A hernia of the diaphragm is a consequence of degeneration of the ligamentous apparatus. The hiatal opening of the diaphragm is abnormally dilated. The abdominal part of the esophageal tube, the cardiac sphincter and the cardiac part of the stomach fall into the formed lumen. Violation of the anatomy of organs interferes with natural functioning. The cardia does not close tightly, the acid irritates the esophageal mucosa, causing damage. Multiple erosions heal with the formation of inelastic scar tissue. The esophageal canal narrows and its conductive function deteriorates.

Dysphagia

Difficulty in swallowing is referred to as dysphagia. The gradations of the disease range from barely noticeable slowdowns in the peristalsis of the esophageal tube to a complete cessation of food movement. The origins of the problem lie in disruption of innervation, for example, after a stroke. Damage to the mucous and muscular layer of the organ is possible due to injuries, chemical and thermal burns. Overgrowth of the mucous membrane with scars leads to tightening of the walls, narrowing of the lumen of the esophageal tube.

Esophageal tumors

Benign or malignant growths form on the walls of the esophageal canal. Benign tumors of the esophageal tube - cysts, polyps - do not metastasize after removal, and the person recovers completely. If such a tumor is viewed and not removed in time, it can degenerate into a malignant cancer. Cancers grow into surrounding tissues and lymph nodes. The tumor hurts, bleeds, and blocks the lumen of the esophageal canal.

Varicose veins of the esophagus

Liver diseases lead to increased pressure in the portal vein system. The esophageal veins become overfilled with blood, stretch, and varicose veins appear. The disease is incurable and threatens human life due to the possibility of severe spontaneous bleeding from the affected vessels.

Barrett's esophagus

A pathological change in the structure of the epithelium of the esophageal canal is named after the British doctor Norman Barrett. Flat multilayer epithelium degenerates into cylindrical epithelium. The impetus for metamorphosis is chronic reflux - a constant reflux of acid from the stomach. The condition of the esophageal mucosa raises serious concerns, as doctors consider it precancerous.

Esophagitis

Esophagitis is an inflammatory disease. The entire esophageal mucosa is affected. The disease occurs for reasons such as:

• constant irritation caused by frequent and excessive consumption of spicy and hot foods;
• organ injuries;
• infectious diseases;
• inflammatory processes affecting the maxillary sinuses and tonsils.

This disease is the main cause of burning in the esophagus and sternum area. Additional signs include:

• sore throat;
• feeling of a lump in the throat;
• belching;
• increased salivation.

During the course of this disease, it is imperative to follow a diet that involves split meals. In this case, the dishes should be ground and warm.

Function and purpose of the esophagus

The human digestive system is a complex anatomical structure, the main function of which is to process and extract nutritional components from food, as well as absorb them into the blood and remove indigestible products from the body. The systemic vital organs are connected to each other by the digestive canal, part of which is the human esophagus - a muscular tube through which food from the pharynx enters the stomach. The motor function of the esophagus, due to muscular contraction of the walls, allows swallowed food to move freely into the stomach along its entire length in a few seconds. The speed of the peristaltic wave in the esophagus is about 5 cm/sec.

Esophagospasm

Esophagospasm is spasm of the walls of the esophagus during normal functioning of the esophageal sphincter. Often, such a disorder occurs in men and mainly in middle and old age. It is usually observed during other diseases of the digestive system or may occur in cases of nervous strain.

If you have this disease of the esophagus, a person complains of pain in the sternum while eating. In addition, the swallowing process is disrupted. Sometimes pain occurs outside of meals, so it can sometimes be quite difficult to distinguish it from pain caused by an attack of angina.

Symptoms of esophageal diseases

Diseases of the esophagus are accompanied by the following symptoms:

• Difficulty swallowing, sensation of the presence of a foreign body.
• Severe, sudden, causeless pain, similar to an angina attack.
• Metallic taste in the mouth, excessive salivation, belching, heartburn.
• Vomiting after eating due to spasm of the lower sphincter.

Thermal and chemical burns are accompanied by purulent mucous discharge. When concentrated caustic substances enter the walls of the esophagus, scars form. With malignant pathogenesis, a person’s weight decreases and he weakens before our eyes.

Such symptoms should alert you and be a reason to visit a doctor. Only he can make a final diagnosis and select adequate treatment.

Reflux esophagitis

Reflux is a disease of the esophagus caused by frequently repeated reflux of stomach contents into the esophagus. This occurs due to insufficient functioning of the esophageal sphincter. Long-term exposure to the esophageal mucosa of bile, gastric juice, and pancreatic juice provokes inflammation and the formation of ulcers, which, when scarred, cause a narrowing of this organ. The disease progresses very slowly.

This disease is often observed in infants. Among the main manifestations it is necessary to highlight the following:

• heartburn;
• burning in the sternum;
• belching;
• taste of bile in the mouth;
• painful sensations.

When regurgitating at night, the contents of the stomach enter the respiratory tract, which provokes a very severe cough and can sometimes cause pneumonia. Over time, a narrowing of the esophagus occurs and the associated difficulty in passing food through it. Complications may include bleeding, scarring in the esophagus, or bleeding.

Classification of esophageal pathologies

Classification of esophageal diseases is carried out according to several criteria:

• speed of disease development – ​​acute and chronic processes;
• degree of damage to the esophageal wall - catarrhal, erosive, ulcerative, necrotic, phlegmonous;
• cause of occurrence: congenital and acquired, infectious and non-infectious, primary and secondary;
• type of affected tissue - mucous, vascular, muscle, nervous;
• type of tumor – benign and malignant;
• type of treatment – ​​therapeutic and surgical.

The classification of diseases of the esophageal canal is inextricably linked with the stomach into which it flows, as well as with the nerves, vessels, and muscles involved in the functioning of the organ.

Achalasia

Cardiospasm or achalasia cardia is a neuromuscular disease manifested by a persistent violation of the opening of the esophageal sphincter when consuming food. The first signs of the disease appear at the age of 20-40 years. Mostly this disorder occurs in women. The reasons for its development are not fully known.

Achalasia is characterized by the presence of pain, reverse reflux of food, impaired swallowing, and regurgitation. The first sign of the disease is difficulty swallowing. In some cases, such symptoms appear completely suddenly against the background of complete health, or may develop gradually. An increase in this symptom is observed after nervous overexcitation, during hasty consumption of food, as well as swallowing poorly chewed food. The degree of disturbance largely depends on the temperature of the food consumed.

With a slight expansion of the esophagus, regurgitation is very frequent, and with a strong expansion it is observed less frequently, but becomes more severe. The pain mainly occurs when the esophagus is full and goes away after regurgitation. When food is retained and rotting processes occur, the following signs are observed:

• nausea;
• belching air;
• increased salivation;
• bad breath;
• burning in the esophagus.

These manifestations are very poorly tolerated and provoke mental disorders, which leads to isolation, increased sensitivity, and embarrassment. It is important to promptly determine the presence of the disease and carry out treatment, as otherwise various kinds of complications may arise. The most common complication is inflammation, which occurs when food is retained for a long time. The chronic stage of esophagitis can lead to esophageal cancer.

Classification and types of inflammation of the esophagus

There are different criteria for classifying the different types of reflux esophagitis . However, they are all based on the histology of the esophageal tissue, i.e. on the type of damage that occurs with this disease.

The first classification is carried out depending on the type of esophagitis:

• Mild reflux esophagitis involves microscopic changes in the mucous membrane.
• Erosive reflux esophagitis, when the inner walls of the esophagus have obvious redness, bleeding and ulcers are clearly visible during endoscopic examination.
• Stenotic reflux esophagitis. It is characterized by the presence of fibrous tissue in the esophagus due to the healing of old injuries. Such tissues cause stenosis (narrowing) of the lumen of the esophagus.
• Barrett's esophagus. Degeneration of the esophageal mucosa (metaplasia). The reason for this degeneration can be found in the body's attempt to counteract acid aggression. The clinical picture is aggravated by ulcers and stenosis. Barrett's esophagus is considered a precancerous pathology. Patients with this disease are 35% more likely to develop esophageal cancer.

Another classification of reflux esophagitis is based on the severity of the lesion:

• Reflux esophagitis of the first degree occurs when erosion and redness are detected in only one fold of the esophageal tube.
• Reflux esophagitis of the second degree is defined when more than one fold is affected, but not along the entire circumference.
• Reflux esophagitis of the third degree, when the folds around the entire circumference are affected.
• Reflux esophagitis of the IV degree, if inflammation is widespread throughout the entire circumference, but erosions have turned into ulcers, and tissue fibrosis and stenosis are present.
• Grade V reflux esophagitis is indicated by the presence of columnar epithelium.

Another classification is based on the size of the lesion caused by reflux esophagitis. At the basis of this classification we have:

• Esophagitis grade A. One or more erosions, but less than 5 mm.
• Esophagitis grade B. Erosions more than 5 mm, but such that they do not reach each other through the folds of the esophagus.
• Esophagitis grade C. Erosion more than 5 mm, touching each other, but not along the entire circumference.
• Esophagitis grade D. Erosions that affect the entire circumference of the esophagus.

There is also a form of reflux esophagitis without the typical symptoms described; it does not have signs of erosions and ulcers of the mucous membrane. Known as non-erosive gastroesophageal reflux disease or by the acronym NERD (non-erosive reflux disease).

Diaphragmatic hernia

A hiatal hernia is a chronic disease associated with displacement of the diaphragm through the esophagus into the chest cavity, stomach, and intestines. Often the disease is completely asymptomatic. In the development of this pathology, factors such as:

• increased intra-abdominal pressure;
• weakness of connecting structures;
• upward movement of the esophagus with dyskinesia.

Depending on the anatomical characteristics of a person, the following types of pathology are distinguished:

• sliding;
• paraesophageal;
• mixed.

A sliding hernia is characterized by the fact that the abdominal part of the esophagus, stomach or cardia through the dilated esophageal opening can freely penetrate into the chest cavity and return back.

A paraesophageal hernia is characterized by the fact that the esophagus remains under the diaphragm, and the stomach penetrates into the chest cavity. The mixed type may have characteristics of both of these types.

The symptoms of a hernia are quite diverse and can mimic diseases of the stomach and cardiovascular system. This often leads to various diagnostic errors. Among the most common manifestations are anemic syndrome, pain, as well as manifestations caused by reflux esophagitis.

The pain mainly occurs after eating food, and also intensifies if the person is in a horizontal position.

Treatment of esophageal diseases

The choice of treatment tactics for the esophagus is based on diagnostic examination data. It is not possible to cure the esophagus for all diseases. Tumors and varicose veins are practically incurable. The patient is forced to take medications for life and be under the supervision of a doctor. An effective method of combating the disease is surgical treatment. Sometimes only surgery saves and prolongs human life. All tumors must be removed.

Surgery

The narrowed esophagus is expanded by introducing bougies. The doctor gradually increases the diameter of the device, bringing the lumen of the organ closer to normal. In severe cases, a gastrostomy tube is removed - the opening of a feeding tube through which food enters the stomach. An organ affected by a tumor or scar adhesions can undergo esophagoplasty - the formation of a new esophagus from intestinal tissue.

Chronic reflux is an indication for fundoplication. The fundus of the stomach wraps around the esophagus. A dense cuff is formed, which prevents acid from entering from the stomach. A modified Toupet fundoplication is preferred. It allows natural reflexes to occur - burping and vomiting. The operation is performed by laparoscopy.

A hiatal hernia is eliminated by returning the gastrointestinal tract to its proper place. The esophageal opening of the diaphragm is sutured. The anatomy and physiology of the esophagus, cardia, and stomach are restored.

Cancerous tumors

Malignant neoplasms of the esophagus are very common. This problem is mainly typical for men aged 50-60 years.

The risk of a neoplasm significantly increases by smoking, alcohol abuse, papillomas, achalasia, and cicatricial changes in the esophagus. Among the main signs of esophageal cancer are the following:

• dysphagia;
• increased salivation;
• discomfort when eating food;
• sudden weight loss.

The onset of the disease is mostly asymptomatic, and this period can last 1-2 years. When the tumor reaches a significant size and leads to a narrowing of the esophagus, the first signs of disruption of the passage of food appear.

At the initial stage of cancer, food seems to stick to the wall of the esophagus or is temporarily delayed at a certain level. As the tumor grows, even well-chewed food no longer passes normally. Therefore, the patient has to consume liquid or semi-liquid food.

Treatment

Speaking about the treatment of acute esophagitis, patients are required to abstain from eating for 2 days. As for medications, I prescribe a drug for heartburn and drugs of the famotidine group. Smoking and drinking alcohol are prohibited.

When eliminating chronic esophagitis, the following types of therapy are prescribed:

• antacids;
• enveloping drugs;
• infusion therapy;
• painkillers;
• antibiotic therapy;
• some folk remedies.

If the disease is particularly complex, surgery is performed. Surgical intervention is also necessary if a complex stricture of the esophagus develops.

Main symptoms

It is very important to know where the esophagus is located and how various diseases and disorders of this organ manifest themselves. Each pathology has its own specific symptoms. Before treatment, a comprehensive diagnosis is required to help select the required method of therapy.

Many people are interested in how the esophagus hurts so that the presence of a problem can be recognized in a timely manner. The painful sensations are mostly sharp, burning and appear after eating food. Each disease has its own specific symptoms, which are important to consider when making a diagnosis.

With esophagitis, chest pain, heartburn, and increased sweating are observed. The pathology can be acute or chronic. In the chronic form, the pain is not as severe as in the acute stage.

Ulcers may be symptomatic or peptic. They develop as a result of long-term use of medications, stressful situations, and exposure to gastric juice on the esophageal mucosa. The main symptoms include pain in the chest, belching, and heartburn.

Vascular pathologies, in particular, varicose veins of the esophagus with bleeding, are accompanied by pain and signs of anemia. In this case, you should definitely consult a doctor, since the disease is detected by esophagoscopy and x-ray.

Congenital anomalies are accompanied by nausea, frequent regurgitation, sore throat and dry cough. In addition, the timbre of the voice may change and salivation may increase. Such diseases are found in young children, which makes it possible to quickly get rid of the existing pathology.

With spasm of the esophagus and its paralysis, difficulty swallowing food is observed. With paralysis, loss of sensation occurs, which leads to the development of pneumonia. Mechanical damage and injury to this organ manifests itself in the form of severe pain when swallowing, bleeding, and general well-being worsens.

A burn of the esophagus is characterized by severe pain in the damaged area. After this, signs of intoxication of the body appear, which manifests itself in the form of high fever, nausea and disruption of the functioning of other organs.

Among the main signs of esophageal cancer is difficulty swallowing when consuming solid foods. If even the slightest discomfort occurs, you should immediately visit a doctor for diagnosis and treatment.

Symptoms

The following symptoms are characteristic of an acute form of inflammation of the esophagus:

• high sensitivity of the esophagus to the temperature of ingested food or liquid;
• problems swallowing a bolus of food;
• painful sensations, sharp or pulling;
• excessive salivation;
• obstruction of the esophagus;
• regurgitation of undigested food.

Hypersensitivity of the esophageal tube to hot foods is a characteristic symptom of catarrhal type of inflammation. The disease usually develops asymptomatically, but during an exacerbation, patients complain of chest pain. The pain can radiate to the lower back, collarbone, abdomen and even to the cervical spine. The syndrome is variable.

Inflammation can also be accompanied by heartburn and regurgitation of food that has not had time to digest. Regurgitation can occur at the moment of belching. Belching increases when bending over or lifting heavy objects.

If the disease is neglected, vomiting, dysphagia, and a feeling that food is stuck and cannot move into the stomach through the esophagus may occur. Also, inflammation of the body of the esophagus has symptoms similar to those of some stomach diseases.

Important: The sensation of a lump in the throat or esophagus disappears in some patients after drinking a glass of warm water.

Symptoms may disappear and return again, which indicates that the disease is advanced. Inflammation of the body of the esophagus requires treatment by a competent doctor. This is the only way to avoid stenosis and malignant degeneration of organ cells.

Unlike the chronic form of esophagitis, the acute form is characterized by a sudden onset of symptoms. The symptoms become unbearable for most patients and the disease requires urgent medical intervention.

The following symptoms are characteristic of esophagitis in chronic form:

• burning in the chest area;
• long-term heartburn, often occurring immediately after eating;
• pain in the chest area.

The pain is moderate and intermittent. Since gastric acid backlog can irritate the airways, patients may experience the following symptoms:

• a sore throat;
• pharyngitis;
• dry cough;
• hoarseness of voice;
• asthma.

Important: In particularly severe cases, patients may experience vomiting of blood or bloody clots. This condition can lead to anemia, weight loss, drowsiness and shock.

Carrying out diagnostics

When the first symptoms of esophageal disease occur, you should definitely consult a doctor so that he can prescribe a diagnosis. Initially, he conducts a survey of the patient, as this helps to make the correct diagnosis. The doctor must clarify the nature and location of the pain, as well as the presence of other characteristic signs. To determine the specific nature of the disease, it is imperative to conduct a comprehensive examination of the esophagus. Diagnostics includes such techniques as:

• examination of the mucous membrane by performing esophagoduodenoscopy;
• fluoroscopy with the introduction of a contrast agent;
• tomography;
• study of sphincter pressure;
• study of chemical indicators of gastric juice.

The doctor draws up a diagnostic plan separately for each patient, and then analyzes the results obtained and selects a therapy method.

Accurate diagnosis

If damage to the esophagus is suspected, in order to exclude oncology, the doctor prescribes laboratory tests, as well as:

• radiography;
• fibrogastroduodenoscopy;
• determination of the pH level of the gastric environment.

In parallel with endoscopy, a biopsy is performed to remove the affected parts of the mucosa for histological examination. If necessary, methods are used to measure the pressure inside the tube and record the contraction of the organ walls.

Video: Endoscopy of the esophagus and stomach

Causes of pain

Pain within the esophagus and the reasons that provoke it can be divided into two groups. The first group represents relatively safe causes. They are associated with a violation of the diet and the introduction of a specific inappropriate lifestyle, which includes the presence of bad habits and low activity. This also includes a love for exotic dishes, which often contain excessive amounts of herbs and spices. Excessive consumption of heavy foods (fried, smoked, spicy) can also cause pain in the esophagus.

The second group of reasons includes the presence of specific ailments and mechanical damage.

Treatment of vascular pathologies

For varicose veins of the organ, treatment is aimed at eliminating the possibility of bleeding and getting rid of the underlying pathology that caused problems with the blood vessels.

Appointed:

• Special diet.
• Adjustment of physical activity towards reduction.
• If necessary, take astringents and antacids.
• For bleeding in a hospital setting, a probe is used in conjunction with balloons that compress the veins in the cardia area.
• Hemostatic treatment is carried out using calcium chloride, and blood substitutes are prescribed.

If an angioma is present, surgical intervention is prescribed to remove the formation using a special loop.

The influence of nervous tension on the appearance of unpleasant symptoms in the esophagus

If such a symptom appears infrequently and is not associated with food intake, it can be assumed that the lump in the throat is caused by mental characteristics, in particular, a tendency to hysteria. With nervous tension associated with anxiety, excitement, or stress, a sensation of a lump appears closer to the pharynx in the area of ​​the esophagus, which is usually called “hysterical”.

After a short period of time, everything usually goes away without any drug intervention or complications. Subsequently, in such cases, you can do several breathing exercises, massage the collar area, and take a mild sedative. Even a simple change of environment will help get rid of this symptom.

A lump in the esophagus may also be psychogenic in nature

From a physiological point of view, this reaction of the body is explained by the fact that during stress the body needs a large amount of oxygen. In this case, the glottis becomes so wide that it cannot be completely covered by the epiglottis. As a result, it is impossible to utter a word, swallow tears, or take a breath.

If the feeling of a coma in the esophagus is accompanied by panic attacks and mood swings, it is necessary to take sedatives, antidepressants, and consult a psychotherapist. The prerogative of a neurologist will be to treat a lump in the throat if it is accompanied by:

1. Dizziness
2. Nausea
3. Apathy
4. Increased sensitivity to weather fluctuations.

In this case, we are talking about vegetative-vascular dystonia, which has recently become the scourge of the modern city dweller. Dysfunction of the nervous system manifests itself in this way. If someone in the esophagus experiences pain between the ribs, which intensifies with exercise, as well as with inhalation and exhalation, we may be talking about intercostal neuralgia - inflammation of the nerve responsible for the innervation of the chest.

Diagnostics: anamnesis, examination and tests

The specialist you should contact if you have the above symptoms is a gastroenterologist. He will make a diagnosis based on a visual examination, analysis of the clinical picture and a number of studies and specific tests.

Correct diagnosis of the disease is necessary to determine the causes of reflux esophagitis, and then carry out the most appropriate therapy.

Let's see what basic tools are used for correct diagnosis:

• Patient's medical history.
• Analysis of the clinical picture.
• Gastroscopy. Insertion of a gastroscope through the mouth, which is a thin catheter with a camera tip through which optical fibers pass light to illuminate the lumen of the esophagus. The footage is displayed on an external monitor. Tissue samples from the esophagus can also be taken through a gastroscope.
• 24 hour pH testing. Measuring pH allows you to determine the amount of juices and acids that enter the esophagus from the stomach in 24 hours.
• Gastroesophageal manometry. Allows you to measure pressure in various parts of the esophagus, and then evaluate the functioning of the cardiac region. The study turns out to be necessary along with pH-metry in the absence of ulcers and erosions.
• X-ray of the stomach using contrast.
• Computed tomography with contrast.
• Exhalation examination to look for Helicobacter pylori.

Elimination of damage and tumors

Injuries to the esophagus are eliminated surgically or non-operatively. If we are talking about burns, their treatment in the second or third stage is carried out exclusively in a hospital setting. In case of a chemical burn, rinsing is done to eliminate any remaining harmful substances. Then the substance that caused the burn is neutralized and a number of measures are prescribed to improve the patient’s general condition. Tumors are eliminated mainly by surgery. Additional effects are provided by chemotherapy and a special diet.

Regardless of the pathology, it is necessary to review the diet, stop smoking, drinking alcohol, limiting the menu of spicy foods - this approach will allow you to maintain health for a long period.

https://youtu.be/F1jN93Ogaf8

Esophageal rupture

The most common cause is injury, but damage can also occur spontaneously.

© shutterstock

Causes

Esophageal ruptures can cause:

• endoscopy;
• surgical intervention;
• Blunt trauma to the abdomen, chest or neck.

Approximately 2-3% develop spontaneous ruptures. The cause of damage may be:

• profuse prolonged vomiting;
• binge eating;
• alcohol abuse;
• pathological spasm of the diaphragm, accompanied by a reflex contraction of the gastric wall;
• abdominal strain.

All this leads to an increase in intraesophageal pressure and the walls rupture.

Symptoms

A sharp pain appears, radiating to the shoulder or lower back. Additionally, the victim appears :

• tachycardia;
• shortness of breath (breathing becomes rapid and shallow)4
• cyanosis of the skin;
• increased sweating.

Symptoms appear suddenly and rapidly increase.

Treatment

Ruptures are treated surgically, when the integrity of the esophagus is restored to the patient. After surgery, to relieve pain and prevent postoperative complications, patients are prescribed :

• antibacterial agents;
• painkillers.

In the first days after surgery, the patient is fed intravenously, and then a liquid diet is selected.

Who treats

In case of ruptures of the esophagus, emergency hospitalization in the surgical department is indicated.

Symptoms

Symptoms of pain in the esophagus differ depending on the underlying disease:

• painful to swallow. The symptom occurs unexpectedly, without apparent reason. At first, discomfort in the larynx occurs after excitement or rapid chewing of food. Problems when swallowing food are usually selective in nature. For example, drinking water may not cause any discomfort, while swallowing dairy products may cause pain. After eating, there is a pressing feeling in the upper part of the sternum, tachycardia, as well as difficulty breathing;
• belching. Occurs immediately after eating or after some time. Bends or physical activity can provoke an unpleasant symptom;
• pain. The esophagus can hurt due to stretching of the walls of the esophagus or involuntary contractions. The attack can last up to several minutes. Often pain in the esophagus radiates to the back, jaw, neck, ear;
• heartburn.

Pain when swallowing saliva may persist for several minutes

Diet and prevention

To prevent pain when swallowing, no special preventive measures have been developed. However, it is recommended to adhere to some simple general principles, which include:

• Maintaining a healthy lifestyle;
• Do not overwork yourself emotionally and physically;
• Drawing up a balanced diet that is enriched with everything required for the body;
• Use only those drugs prescribed by a specialist - strictly adhere to the daily dosage and duration of treatment;
• If possible, avoid injury to the esophagus;
• Undergo a full examination at the clinic and be sure to visit a gastroenterologist.

You should not self-medicate and create a diet for yourself. You definitely need to visit a doctor.

Diagnostic measures

How to treat inflammation of the esophagus depends on the degree of damage to the organ. To identify the type of disease and its cause, you need to visit a doctor. Based on the complaints, the doctor will prescribe an examination.

It includes:

• donating blood and urine for general analysis;
• performing endoscopic biopsy. The technique involves swallowing a probe that has a light bulb and a small video camera on it. During the examination, redness, swelling and damage to the mucous membrane can be recognized;
• radiography using a contrast agent;
• ultrasound diagnostics of the esophagus;
• Conducting daily pH measurements. The study can be performed within 24 hours or take place instantly. If the pH level is less than 4, then this indicates the development of a pathological process.

The diagnosis is made based on the results of the examination. The root cause and degree of development of the disease are also determined.

Useful video

https://youtu.be/5lu-xgrVf6s

A very unpleasant and frightening symptom can be sensations in the area of ​​the esophagus, similar to as if a lump had appeared in it. A person with such manifestations cannot maintain composure for a long time; he begins to “try on” various diagnoses, not knowing which doctor to turn to. Such symptoms can be signs of various pathological conditions of organs and systems of the human body, and most of these pathologies are perfectly treatable by modern medicine.

Symptoms of benign esophageal tumors

Most benign neoplasms are small in size, have no clinical manifestations, and are often an incidental finding during FEGDS. Once the tumor has reached a sufficient size, patients may complain of difficulty swallowing, sensation of a foreign body in the chest, nausea, heartburn, and pain while eating.

A distinctive feature of a benign process is the slow progression of symptoms over several years due to the sluggish growth of the tumor. The general condition, as a rule, does not suffer.

Signs and stages of esophagitis

Signs of the disease depend on the cause, stage, and rate of development of the pathological process.

Symptoms of esophagitis

The acute process is characterized by rapidly increasing symptoms. There is a sharp, severe pain when swallowing. The temperature may rise even if the disease is non-infectious. A painful burning sensation in the esophageal canal, increased salivation, and a general loss of strength due to extensive inflammation are the main symptoms of acute esophagitis. The patient is plagued by burning pain behind the sternum and difficulty passing food through the esophageal canal. It feels like a lump is stuck in your throat.

With chronic acid reflux or hiatal hernia, the main problem is heartburn. It intensifies 20 minutes after eating, in a lying or bending position. Cough with esophagitis is a consequence of acid belching thrown into the nasal cavity and aspiration of hydrochloric acid by the lungs.

A common occurrence among alcoholics is morning “hungry” vomiting of mucus mixed with scarlet blood streaks. Severe bleeding from ulcers and erosions turns the stool dark brown - the color of digested blood. Painful swallowing leads to a lack of appetite, severe emaciation of the patient, and metabolic disorders.

The chronic process proceeds latently, characterized by blurred symptoms or their mimicry of other diseases. A bright clinical picture is visible during an exacerbation when exposed to one or a complex of provoking factors.

Stages of esophagitis

Depending on the area of ​​tissue damage to the esophageal canal, there are 4 degrees of esophagitis:

• grade A esophagitis – an area of ​​the mucosa up to 0.5 cm in diameter is affected, and the affected area is limited by the folds of the mucosa;
• The degree of the disease means that there are two or more lesions up to 1 cm in diameter, surrounded by healthy folds of the mucosa;
• degree C is observed when the pathology has spread to two or more folds of the mucosa, but the total damage to the circumference of the organ does not exceed 3/4;
• in grade D, the spreading of mucosal defects over more than 3/4 of the circumference of the esophageal tube is noted.

Based on the depth of penetration of tissue defects, superficial and atrophic varieties of the disease are distinguished. Superficial esophagitis affects exclusively the mucous layer and is often found in the abdominal part of the esophageal canal. Detected at stages A–C.

Atrophic esophagitis is characterized by a chronic course, when healthy tissues gradually lose their functional abilities and pathologically degenerate. It is a threatening precancerous condition. Occurs at stage D.

Cancers

Cancers of the esophagus most often appear in those people who lead an unhealthy lifestyle - they smoke a lot and drink alcohol excessively, and regularly inhale harmful chemical fumes. To reduce the risk of developing pathology, it is important to lead a healthy lifestyle. Do not overuse spicy or hot foods. Warm food is the best option. If a person develops cancer, the following symptoms occur:

• weakness;
• the esophagus hurts in the chest, it hurts to swallow;
• increased salivation;
• fast fatiguability.

If one of the symptoms appears, you need to visit a doctor. At the initial stage of disease development, therapy is carried out much faster and more effectively. If you do not contact medical personnel in a timely manner, therapy will be carried out using the surgical method in a hospital setting.

Is it possible to cure the disease?

When the tumor is large and has metastasized, unfortunately, it is not possible to be completely cured. The disease can be defeated with early diagnosis at stage 1, when there is no metastatic damage to the body, if radical surgery is performed in a timely manner.

According to statistics, the five-year survival rate of patients with stage 1 after surgical treatment is more than 90%, with stage 2 – up to 40-50%, with stage 3 – up to 10%.

If there is involvement of regional lymph nodes, the prognosis for survival is much worse. Clinical stage 4 involves palliative, symptomatic treatment, and the life expectancy of patients varies from 5-8 months to one year.

The dominant treatment methods for patients with this pathology are surgery and radiation. Drug therapy also has its place, but mainly as an additional method, or as an element of palliative, symptomatic care.

Treatment of acute and chronic esophagitis

The principles of therapy for esophagitis are common to all diseases of the upper gastrointestinal tract and in most cases are reduced to the following effects.

• Diet. The closer the inflammation is to the external gastrointestinal tract, the more serious the diet should be. So, with esophagitis, food should be warm or slightly cooler than 37 degrees (that is, it should be thermally gentle on the mucous membrane); not be hot, sour, spicy, fried and fatty (sparing the mucous membrane chemically); not be coarse fiber (persimmon, seeds, and other sources of coarse fiber are excluded). Preference is given to steamed food. The diet should not contain fizzy drinks, lemonades, beer and other sources of carbon dioxide.
• In the presence of heartburn and existing reflux, drugs are used that normalize the motor function of the stomach and esophagus: Domperidone, Motilium, Cerucal.
• Antacids that relieve heartburn have a good effect. Treatment is carried out with drugs such as Smecta, Phosphalugel and Almagel-A. The latter drug, in addition to the antacid medication, contains an anesthesin, which relieves pain well.
• An important link in the treatment of esophagitis against the background of increased acidity is the prescription of proton pump blocker drugs (Omeprazole).
• Sometimes it is necessary to combat high acidity by prescribing H2 blockers (Famotidine). Such therapy should be carried out by a gastroenterologist.

Types of inflammatory process in the esophagus

Inflammation of the esophagus is considered one of the common problems.
However, 40% of patients do not have any significant symptoms. Esophagitis is usually divided according to the course, nature and prevalence of the disease.

There are two types of inflammatory process. The acute type of the disease has three degrees of damage as follows:

• minor damage to the mucous membrane. Erosions and ulcers do not form;
• lesions of the membrane over the entire surface. Necrotic changes are present in some places;
• damage to the submucosal layers. Defects and perforation of the esophagus are formed, which leads to internal bleeding.

Chronic disease is divided into main stages as follows:

• hyperemia. In this case, there are no erosions;
• small erosions of the mucous membrane;
• an increase in the size of the ulcers and their ingrowth into the surface;
• reduction in the diameter of the esophageal opening. This process leads to difficulty in its passage.

Esophagitis is also divided according to the location of its spread and can be:

• distal. Erosion is long-lasting and affects the lower region of the esophagus;
• proximal. The upper sections are damaged;
• total. Ulcers spread over the entire surface of the mucous membrane.

The inflammatory process in the esophagus is divided according to the nature of the disease and can be:

• catarrhal Only the top of the esophagus is damaged. Considered to be a mild injury;
• pseudomembranous. The submucosa is not subject to inflammation;
• edematous. Leads to swelling of the mucous membrane;
• hemorrhagic. There is hemorrhage in the esophagus;
• exfoliative. The submucosal layer of tissue is exposed to inflammation;
• necrotic. Formed during severe and prolonged poisoning;
• phlegmonous. The cause of the pathology is injury to the esophagus by foreign objects;
• erosive. Involves the formation of erosions of ulcers on the surface of the organ. Each time they spread more and more of the mucous membrane and affect the deeper layers.

The latter type of disease occurs only in the final stages. The cause of erosive esophagitis is most often a burn or infection.

Painful sensations can occur with any form of the disease, even if there is only redness and swelling with catarrhal esophagitis.

Surgical treatment of esophageal cancer

Surgical treatment is an extremely complex and responsible intervention, since the tumor is localized near vital organs and blood vessels.

The goals of surgical treatment are as follows:

• Complete tumor removal in the first clinical stages of cancer.
• Maximum resection of the tumor in more advanced stages, and then the use of other treatment methods (radiation, chemotherapy).
• Alleviation of the patient's condition in inoperable cases, at later stages.
• Reconstructive restoration of the digestive tube after surgery to remove the esophagus.

It has been proven that it makes sense to carry out surgical intervention for the purpose of complete cure in the first stages of the oncological process, when there are no distant metastases and deep germination into nearby organs.

The best long-term results of surgical intervention are observed when cancer is localized in the lower and thoracic esophageal sections; tumors in the upper sections are often difficult to remove surgically.

Surgical treatment includes various methods and methods aimed at resection (removal) of a section of the esophagus, or its extirpation - removal of not only the organ itself, but also regional lymph nodes.

After removal of part of the organ, esophageal-gastric anastomoses are performed, usually during operations on the lower and middle esophageal sections.

More radical operations require subsequent plastic surgery - transplantation of a section of intestine (small or large) or reconstruction of the esophageal tube using the stomach wall.

Palliative operations

There are separate palliative operations - aimed at alleviating the condition in patients with stage 4.

When performing these surgical interventions, doctors adhere to the following goals:

• Relieve the patient from problems with the passage of food.
• Improve quality of life.

Palliative surgical operations include: the formation of anastomoses for the passage of the digestive tube, bypassing the tumor that prevents the passage of food, the application of a gastrostomy, the installation of a special tube through which the patient will receive liquid nutrition and medications.

Less traumatic interventions are surgical bougienage, restoration of the esophageal lumen, and transtumor intubation. These methods help restore the patency of the esophageal tube and establish the patient’s nutrition through the mouth (enteral).

There are modern methods that promote cauterization of cancer cells and have a cytostatic effect on metastases.

These methods include:

• Targeted laser coagulation.
• Photodynamic therapy.
• Argon plasma coagulation.
• Stenting.

These minimally invasive techniques can be performed on an outpatient basis during endoscopy.

Lewis operation

https://youtu.be/tMbYnj1cabk

This is the most common surgical intervention for esophageal cancer, if the tumor is located in the lower and middle part of the organ.

During this operation, an esophageal resection is performed and immediately followed by the formation of an esophageal-gastric anastomosis: a transplant is formed from the greater curvature of the stomach and a tube is formed, which will subsequently be connected to the remaining esophageal part.

During this intervention, the patient is under anesthesia, incisions are made through the abdominal cavity and chest. The operation is quite complex and requires highly qualified and professional surgeons.

How long does cancer surgery take?

The duration of possible surgical interventions varies. Duration depends on:

• Volume of the operation.
• Its stages.
• The need for subsequent reconstructive interventions (plasty).

Some minimally invasive procedures can take no more than 1 hour; as a rule, we are talking about endoscopic interventions: for example, bougienage manipulation. Interventions that require removal of part or the entire organ take much longer: laparoscopic - from 8 to 10 hours, abdominal - about 3-5 hours.

Surgeons often resort to a two-stage operation: first, stage 1 is carried out - removal of the organ, and after a few months stage 2 - plastic surgery, to restore the natural passage of food through the gastrointestinal tract. In this case, from one to several months pass between operations.

Argon plasma cauterization

A modern method of palliative treatment of a tumor, which is a type of laser coagulation. The method is based on the effect on cells of high-frequency current with the assistance of gas - argon. During coagulation, the tumor tissue that is targeted is burned out.

At the same time, the resulting zone of necrosis is shallow - no more than 3 mm, which allows the muscle layer of the organ to remain undamaged. Using an endoscope, the sensor is placed in close proximity to the lesion and acts on it without contact.

The method allows to slow down the growth of tumor cells, fights metastatic foci, increases life expectancy and its quality.

Esophageal stenting for cancer, life expectancy

The stenting procedure is a minimally invasive surgery and involves placing a special implant in the esophagus, which allows you to restore its patency, improve the quality of life and restore the passage of food and water.

This operation is indicated for patients who:

• They have a malignant tumor at a late stage.
• Due to age or concomitant diseases, they cannot undergo radical surgery.
• Suffer from dysphagia of critical severity.
• We have undergone surgery and need a frame to prevent the formation of postoperative esophageal stenosis.

Stenting is a gentle operation that allows you to restore the patency of an organ over an extended area.

After its implementation, the life expectancy of patients increases: according to clinical observations of 56 patients with inoperable cancer who underwent stent placement, 35.7% of them (20 people) lived for more than a year, and 16% (9 people) lived for more than two years.

The advantage of stenting is an increase in life expectancy and improvement in its quality, social adaptation of patients.

How to treat esophageal cancer in the elderly

In old age, often the state of health and concomitant pathology do not allow surgical intervention for oncological pathology.

Surgeries on the esophagus are very complex interventions with a high degree of risk, so elderly patients with pathologies of the cardiovascular and respiratory systems do not tolerate them well, which is why they are rarely operated on.

For elderly patients who are contraindicated for radical surgical treatment, radiation therapy, chemotherapy, or combined treatment using minimally invasive endoscopic palliative surgery followed by radiation and chemotherapy treatment is recommended.

Endoscopic stenting and laser coagulation are low-traumatic, virtually bloodless procedures, which in some cases are indicated even for frail elderly patients; they are well tolerated and rarely cause complications.

Treatment should be prescribed by an oncologist individually, taking into account the concomitant diseases of the elderly patient, the extent of the cancer and its stage, as well as the localization of the process.

Radiation therapy

A treatment method widely used as a method of radical tumor control or as palliative care. The essence of radiation therapy is to use radiation and deliver it to the cancer site.

Exposure to X-ray, gamma radiation from Cs, Co, and densely ionizing nuclear particles affects cells cytostatically, stopping the growth of the formation or destroying it.

There are external irradiation and intracavitary irradiation - the introduction of special radioactive drugs using a special probe into the esophageal lumen. It is even possible to combine both methods.

Radiation treatment can be an independent method, precede surgery, or be prescribed after surgery. The method can pursue several goals: radical treatment - complete destruction of the tumor, palliative treatment - maintaining the vital functions of the body and prolonging the patient’s life with improving its quality.

Radical radiation methods are used when the patient presents early, the tumor size is small, there are no metastases, the general condition is satisfactory and blood counts are normal. Radiation may precede surgery. It is prescribed to relieve inflammation, reduce the size of the formation and make it operable.

Chemotherapy

Drug treatment with cytostatics as an independent method is used only as a palliative method for advanced forms of oncology; more often it is prescribed as one of the components of treatment methods together with radiation and surgery.

For this pathology, the most effective medications are:

• Cisplatin.
• Fluorouracil.
• Paclitaxel.

The combination of the above drugs provides a good effect in almost 50% of patients. However, many people receiving chemotherapy have to interrupt the course of treatment due to severe side effects due to the high toxicity of the drugs.

Medical nutrition

Thanks to proper nutrition, you can not only improve your overall health, but also speed up the recovery process for patients with diseases of the esophagus. In the process of treating pathology of this organ, it is recommended to include in the diet:

• vegetable soup;
• lean meat;
• boiled fish;
• dried fruits compote;
• mint and chamomile tea;
• porridge;
• vegetable stew;
• milk jelly.

If the esophagus in the chest hurts when swallowing, you need to follow a diet. Do not use:

• smoked food;
• spicy food;
• fatty foods;
• semi-finished products;
• tomatoes;
• sausage;
• baking;
• smoked salted fish;
• alcohol;
• fat meat;
• fast food;
• sweets;
• fruits;
• drinks that contain caffeine;
• chips.

In addition, you must follow the following recommendations from specialists:

1. Consume food slowly: it is important to chew each bite thoroughly.
2. Eat small meals - up to 6 times a day. Portions should be small.
3. Regularly consume fermented milk products.
4. Food should be warm, not hot or cold.
5. While consuming food, you should not drink water.
6. Food must be boiled or baked.
7. It is better to grind difficult-to-digest foods using a blender; this will reduce the risk of injury to the esophagus.
8. It is recommended to consume food at the same time.

Thanks to such simple recommendations, you can improve your overall health and the functioning of your gastrointestinal tract.

Mechanical damage

When food passes, pain in the esophagus often occurs due to microtrauma of the esophageal wall.

© shutterstock

Causes

Cause damage:

• swallowing large pieces of solid food;
• entry of foreign bodies.

The most common impact of fish bones is when the bone digs into the esophageal wall, damaging not only the mucous membrane, but also the muscle layer.

Symptoms

Signs of damage to the upper digestive tract depend on the nature of the injury. Microtraumas of the esophagus hurt slightly only during the passage of food, and a foreign body stuck inside the organ provokes :

• acute pain;
• spasm of the esophageal opening;
• swallowing disorders.

Patients with a foreign body complain of unbearable pain that cannot be eliminated with painkillers.

Treatment

Therapy depends on the nature of the damage. In mild cases, no treatment is required: patients are prescribed a gentle liquid diet to reduce mucosal irritation.

If the cause of the pain is due to the entry of a foreign body, then the person undergoes a gastroscopy and the foreign object is removed. After removal the following is prescribed :

• analgesics;
• antibiotics;
• gentle nutrition.

In case of severe damage to the mucous membrane and muscle layer, the patient is hospitalized in the department.

Who to contact

When the esophagus hurts after eating and the painful manifestations cause excruciating discomfort, you need to urgently visit a gastroenterologist or surgeon, or call an ambulance. If you experience moderate pain, you need to be examined by a gastroenterologist.

Types of esophageal tumors

Tumors of the esophagus are very diverse. The most common ones are presented in the table below.

Table 1. Types of tumors

Tumors of the benign esophagus are relatively rare: their share in the general oncological pathology of the esophagus does not exceed 5-10%.

Among malignant neoplasms, 90% are cancerous tumors (epithelial origin)

The speed and severity of the manifestation of clinical symptoms of a tumor of the esophagus largely depends on the method of its growth:

1. Inside the esophagus (exophytic): reduces the free lumen, quite quickly accompanied by the appearance of complaints from the patient;
2. Inside the wall of the esophagus: does not extend beyond its borders. It can cover it in the form of a ring, which gradually narrows and makes it difficult to pass, or have the appearance of a separate plaque or a disintegrating ulcer.
3. Mixed.

The mechanism of pain when swallowing

The esophagus is a muscular organ that is responsible for delivering food from the mouth to the stomach. The tube consists of 3 sections where there are narrowings. In these segments, food is more difficult to promote. Discomfort in the esophagus when swallowing occurs during the passage of food or due to a pathological process of the mucous epithelium. Pain, or in medicine this manifestation is called odynophagia, occurs periodically and is accompanied by additional symptoms. Sometimes this appears in healthy people as an independent phenomenon.

Spasmodic pain in the esophagus when swallowing occurs in the lower part of the tube. The esophageal cardiac sphincter is located in this segment, where many nerve endings are localized. Receptors help prevent low-quality foods from entering the stomach. When dangerous substances are detected in food, the sphincters begin to push out the food. Sometimes the entire tube spasms.

The duration of discomfort in the esophagus when swallowing is 30 minutes. Depending on the cause of the pain, the duration may increase or infrequent discomfort may occur within 20 seconds.

The nature of the manifestation of pain syndrome is different:

• cutting;
• dull or lumpy feeling;
• baker;
• burning.

Pain when swallowing in the esophagus is confused with a cardiac manifestation. Unpleasant sensations appear not only after eating, but also due to physical activity or during sleep.

Who is at risk?

Pain when swallowing often occurs in people over 60 years of age. When the disease is diagnosed, reflux disease is discovered. In most cases, people at risk are those who are prone to depression, anxiety, or are easily susceptible to stressful situations. It becomes painful to swallow if there are problems with a sharp increase in blood pressure. Excessive consumption of alcoholic beverages at any age poses a risk of causing discomfort.

How it works

Understanding the causes of heartburn in the esophagus is impossible without knowing how the upper gastrointestinal tract works.
The main purpose of the esophagus, as its name suggests, is to transport a swallowed bolus of food (bolus) from the larynx to the stomach. Its unhindered passage is ensured by abundant impregnation with saliva, a mucous coating of the esophageal walls that facilitate smooth sliding, and special wave-like, “pushing” contractions of the esophagus. This activity of the esophageal walls is called peristalsis. The esophagus, which is a hollow tube, is limited above and below by special valves (the so-called sphincters). The upper esophageal sphincter (UES) is a narrow and dense muscle ring that prevents air and foreign objects from accidentally entering the esophagus. It opens reflexively and exclusively when swallowing.

The purpose of the lower esophageal sphincter (LES) is also to protect the esophagus and prevent the backward movement of food. In fact, it works to close and allows food to pass exclusively in the direction of the stomach. The opening mode of the LES is not directly related to swallowing, but rather depends on the periodicity and amplitude of the peristaltic waves of the esophageal walls conducting the bolus.

Prevention of esophageal diseases depending on etiology

Prevention of esophageal cancer

To detect an oncological process (cancer, carcinoma, lymphoma, leiomyosarcoma), annual preventive examinations .

The earlier cancer is diagnosed, the better the prognosis. Timely treatment will help prevent complications: metastasis, tumor perforation, bleeding, stenosis, aspiration pneumonia, cachexia, etc. Prevention also consists of timely treatment/elimination of predisposing factors :

• diverculae;
• achalasia;
• IDA;
• leukoplakia;
• hernia;
• bad habits;
• irrational and unbalanced nutrition;
• Barrett's esophagus, etc.

Prevention of Barrett's esophagus

Diseases of the esophagus are sometimes associated with the entry of stomach acid into the organ, which leads to ulcers, erosions and changes in the structure of the mucosa. Barrett's esophagus is characterized by abnormal metaplasia. The condition is recognized as potentially precancerous and is associated with gastroesophageal reflux. Therefore, prevention is based on early detection and treatment of the disease:

• Visit a gastroenterologist once every six months, and if you have alarming symptoms, see your doctor regularly.
• Watch your excess weight. Obesity often causes the progression of esophageal diseases.

This is due to the fact that the transport of stomach contents to the duodenum slows down significantly. As a result, increased pressure is formed in the organ and the contents are released into the esophagus along with hydrochloric acid. In addition, an increase in intragastric pressure contributes to a change in the functional state of the lower esophageal sphincter and weakening of the legs of the diaphragm. This is what provokes reflux esophagitis.

If the patient has previously been diagnosed with reflux esophagitis or has increased stomach acidity, then drugs from the proton pump inhibitor group are prescribed for treatment or prophylactic purposes to prevent relapse. These antisecretory drugs effectively suppress the production of hydrochloric acid and have high pharmacological safety. Such means include:

Zulbex

The medicine inhibits the secretion of stomach acid. It is not addictive and side effects are rare. It is recommended to take 1 tablet per day for 1 month. Contraindicated in children under 12 years of age, during pregnancy, lactation, and with severe kidney and liver diseases.

Losek

The drug inhibits the release of hydrochloric acid into the lumen of the stomach. For exacerbations of acid-related diseases, it is recommended to take 20 mg 1-2 times a day for a month. Contraindicated in pregnancy, children, during breastfeeding and if you are allergic to the active substance.

Ursodeoxycholic acid

If reflux of bile into the esophagus is diagnosed, then ursodeoxycholic acid is prescribed. It reduces the saturation of bile and promotes the gradual dissolution of gallstones. There are no age restrictions. But not recommended for hypersensitivity to the active substance.

If there are complaints of stomach fullness or a feeling of bloating, then enzyme medications that do not contain bile acids are prescribed. They improve the digestion process and contain enzymes.

Kreazim

The drug is intended to optimize the digestive process. Contains enzymes that help fully absorb food components entering the gastrointestinal tract. The capsules are coated with a acid-resistant shell, which prevents the influence of stomach acid on the active ingredients. It is recommended to take 1 capsule with the main meal. The duration of therapy varies from several days to several months, depending on the intensity of the disturbing symptoms. In this case, you should increase your fluid intake. Contraindicated in acute pancreatitis, hypersensitivity.

Festal

Popular enzyme preparation. It compensates for the insufficiency of the secretory function of the pancreas, and also normalizes the biliary activity of the liver. Contains enzymes that improve the absorption of carbohydrates and proteins, the breakdown of plant fiber and other digestive processes. It is recommended to take 1-2 tablets 3 times a day. in a day. The duration of therapy depends on the complexity of the gastrointestinal tract disorders. Contraindicated for hepatitis, hypersensitivity, acute pancreatitis, children under 3 years of age, and intestinal obstruction.

Prevention of cicatricial stenosis of the esophagus

Cicatricial narrowings are characterized by complete or partial blocking of the lumen of the esophagus, which interferes with the normal swallowing of food and saliva. They are more often diagnosed in patients who have suffered a chemical burn from acids, alkalis and other aggressive liquids. Less common in patients with reflux esophagitis, tumors, hiatal hernia, gastritis. The pathology has 5 stages of development: from the free passage of any food, but with uncomfortable swallowing, to the complete inability to take any food and even swallow saliva.

To prevent the progression of pathology and eliminate the mechanical obstruction in the esophagus, an integrated approach is necessary:

1. Nutrition correction.
2. Conservative therapy: prokinetics, enzyme agents.
3. Surgical intervention (endoscopic bougienage).

Diet No. 1 is recommended for all patients. It has sufficient energy value (daily calorie content up to 3000 kcal) and a balanced ratio of essential nutrients. Vegetable soups, cereals, vegetables, herbs, lean meat, fish, dairy products, eggs, baked pies, etc. are allowed. Dishes should not irritate the esophageal mucosa, be hot or too cold. Pureed products with a mushy consistency are recommended. Number of meals: 5-6.

To improve motility of the esophagus and stomach, prokinetics are prescribed. These drugs prevent food from stagnating, increase the amplitude of contraction of the esophagus, and promote rapid healing of erosions. The drugs do not affect the secretory function of the stomach. They have an antiemetic effect. Not recommended for long-term use, because can cause various side effects: drowsiness, anxiety, headache, weakness, etc.

Motilium

A well-known drug of the prokinetic group. Reduces the severity of dyspeptic symptoms (heartburn, bloating, belching, nausea, etc.) by accelerating the evacuation of the food bolus into the duodenum. It is also used to relieve vomiting. It is recommended to take 1 tablet 15 minutes before meals. Contraindicated in case of gastrointestinal bleeding, pregnancy, lactation, mechanical intestinal obstruction.

Prevention of vascular pathologies of the esophagus

The main symptom of vascular disease of the esophagus is esophageal bleeding. It occurs due to injury to an organ or a nearby large vessel, compression of the portal vein by tumors, cirrhosis, etc. Impaired outflow and stagnation of blood in the vascular system of the esophagus leads to various pathologies, such as varicose veins.

The basis of prevention is timely treatment of pathologies that provoke vascular disease of the esophagus. To stop bleeding, hemostatic drugs are prescribed, for example, Pituitrin.

Pituitrin

The product narrows the capillaries, regulates the constancy of osmotic pressure. It is administered intravenously 10 units in 200 ml of glucose solution (5%) or sodium chloride. Contraindicated in cases of severe atherosclerosis, high blood pressure, and thrombophlebitis.

It is also recommended to avoid heavy physical activity and heavy lifting, because... they create high pressure on internal organs, which can cause bleeding. You should not take medications for a long time that can cause bleeding, for example antiplatelet agents - they are taken to prevent blood clots (Aspirin, Upsarin Upsa, etc.).

Classification

Diseases of the esophagus can have different origins, course patterns, severity, and symptoms. For ease of diagnosis, they are divided into the following groups:

• Congenital anomalies detected at an early age:

1. Extensions of different parts of the organ.
2. A cyst located inside a cavity or attached to the outer wall.
3. Tracheoesophageal fistula is an opening connecting the trachea and esophagus.
4. A diverticulum is a protrusion of the wall of an organ in the form of a sac into the surrounding cavity.
5. Stenosis is a narrowing of the tube lumen.
6. Absence of an organ or its shortening.
7. Partial or complete doubling.

• Specific and nonspecific acquired diseases:

1. Diverticula.
2. Acute, chronic and infectious inflammation (esophagitis, stenosis, peptic ulcer).
3. Vascular diseases (varicose veins of the esophagus, hemorrhagic angiomatosis, angioma).

• Diseases that impair the functioning of the organ - neuromuscular dysfunction:

1. Esophagospasm is a sharp short-term spasm, contraction of the muscular wall of the esophagus.
2. Atony, paralysis - decrease or complete loss of muscle tone of the tube walls, impaired peristalsis.
3. Achalasia is a neuromuscular disease that prevents the passage of food due to decreased peristalsis of the organ and the lower sphincter (cardia), which connects to the stomach, being constantly closed.

• Tumor diseases:

1. Benign tumors (lipoma, rhabdomyoma, leiomyoma, angioma, myxoma, neuroma, fibroma).
2. Malignant tumors (cancer - sarcoma, epithelioma).

• Damage to the esophagus:

1. Mechanical injuries leading to the appearance of perforations (holes) in the walls of the tube.
2. Chemical burns that cause scarring and adhesions.
3. Foreign bodies entering the cavity and getting stuck.

Causes

The exact causes of esophageal cancer have not been established, but scientists have concluded that external factors, such as frequent consumption of hot food and alcohol, may contribute to the appearance of the tumor. Most often, people living in Iran, China, and Central Asia encounter a malignant or benign tumor of the esophagus, which indicates such factors as eating a large amount of marinades, seasonings, molds and nitrosamines, along with a lack of fresh vegetables and fruits in the diet, as well as selenium.

Risk factors include vitamin deficiencies, especially a lack of vitamins A and C in the body. Smokers are four times more likely to encounter pathological cell degeneration, and in drinkers, esophageal tumors are found twelve times more often. It is not uncommon for an oncological process to develop several years after an alkali burn. In relatively mild diseases such as esophageal achalasia, esophagitis or Barrett's syndrome, there is a ten percent chance of carcinoma occurring.

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Esophageal achalasia

This disease is also common. It manifests itself as a spasm of the lower esophageal sphincter, which is accompanied by pain and heaviness behind the sternum. The disease is classified as a neuromuscular disease. Vomiting rarely accompanies the disease at the beginning, but as the disease progresses, it can occur after every meal. In addition, body weight decreases and a person rapidly loses weight.

The cause of achalasia cardia has not yet been established

At the beginning of the development of the disease, signs of the disease can be stopped with the help of antispasmodic drugs, for example, drotaverine. If drug therapy is ineffective, surgical intervention is resorted to. Typically, the operation involves widening the lower esophagus. It can be performed either laparoscopically or with an abdominal incision.

It's like something is stuck

Everyone has felt the feeling of a lump in their chest at least once in their life. During nervous stress, the secretion of mucus in the esophagus decreases, and this makes it difficult for food to pass through. This feeling is considered short-lived and goes away after the nervous condition improves.

But there may be other reasons for this feeling. There are quite a lot of them. The feeling of a lump in the chest may even be an early sign of the presence of a tumor, for this reason, if it is present, specialists carefully examine the patient’s condition.

To determine why the patient has a feeling of a lump in the chest area, the specialist takes into account such nuances as:

• A lump in the chest can be caused by a disease of the organs - esophagus, heart, lungs, muscles;
• The sternum contains a complex complex of nerve endings and choroid plexuses, for this reason any disturbance can cause discomfort;
• Organs that are located inside the abdomen can cause a feeling of fullness in the chest;
• Organs located in the abdominal area can cause pain.

If you feel a lump in your throat, you need to determine the cause of the disease. If the disorder is determined by increased acidity of the gastric tract, then you need to take medications to reduce the concentration of gastric juice and treat gastritis or peptic ulcer.

If the feeling of a lump in the chest develops due to diseases of the heart and blood vessels, then you should perform a cardiogram and consult a cardiologist. The doctor will prescribe the required medications.

Spinal osteochondrosis and radiculitis. He will also detect pathological reflexes that lead to spasm of the esophagus.

If you have a bruised sternum, you should consult a traumatologist.

Treatment of a lump in the throat with the help of traditional medicine brings temporary relief, but over time the signs of the disorder will only intensify. It is important to detect them in the initial stages and seek the help of doctors.

Don't think that the symptoms will disappear on their own. Over time they will only spread and progress.

Nutrition for esophageal cancer

Patients with this diagnosis, to varying degrees, experience symptoms of dysphagia - swallowing disorders, and also have stenoses of varying severity.

To facilitate the passage of the food bolus, all consumed products must be subjected to mechanical processing: food must be crushed to a mushy state, it must not contain solid inclusions or any particles that can clog the stenotic area of ​​the digestive tube.

Mucus-like porridges, puree soups, jelly, butter, meat or fish soufflé, pudding, grated fresh fruits and vegetables easily pass through the esophagus without injuring its membranes.

If the degree of stenosis is extremely pronounced and the patient cannot swallow not only liquid food, but even water, he must be transferred to parenteral (intravenous) nutrition with special preparations containing amino acids, lipids, and vitamins.

There are special powder mixtures with a balanced content of nutrients and vitamins, which are prepared by dissolving in warm water.

Canned baby food purees (meat, fish, vegetables, fruit) are a good alternative for patients who have difficulty swallowing coarser foods.

Since patients with cancer of the upper gastrointestinal tract have a deficiency in the intake and absorption of nutrients, their diet should be enriched with a high content of proteins and vitamins.

The consumption of alcohol, carbonated drinks, chocolate, spices, spicy and salty, smoked and fried foods is strictly prohibited. Any products that can irritate the mucous membrane.