Esophageal disorders may produce a burning sensation in the esophagus, which may also feel like chest pain or back pain; excessive belching; a backflow of stomach contents into the throat (regurgitation); and/or difficulty swallowing.
Diagnostic Studies
A physical exam, blood tests, radiology tests such as barium Xray, as well as endoscopy of the esophagus, esophageal pH acidity test, or esophageal manometry test may be required for diagnosis of the esophageal disorder.
Gastroenterologists are expert at performing endoscopies. The endoscope is a flexible tube placed through the mouth and passed down the throat to see inside the esophagus and into the stomach and first part of the small intestine (duodenum). Endoscopy allows thorough examination of the esophagus, its size, and the color and texture of the lining.
The esophageal manometry test assesses the peristaltic activity of the esophagus and helps to evaluate the function of the two sphincter muscles, one at the top end of the esophagus near the base of the throat and one at the lower end of the esophagus leading into the stomach. Weak sphincter muscles may allow increased backflow of acid from the stomach back into the esophagus. Failure of the lower sphincter muscle to relax, such as in a disorder called achalasia, may lead to difficulty in swallowing. Overly strong esophageal muscular contractions may lead to painful spasms which can mimic chest or back pain.
The normal lining of the esophagus is usually pink in color. In the condition called Barrett's esophagus, the endoscopic exam shows that the lining of the esophagus had changed from its normal pink color to a salmon color. A biopsy of the tissue is done to confirm the diagnosis. If the biopsy shows a change called intestinal metaplasia (where the esophageal lining is even more like the intestine than the stomach), then the tissue is considered precancerous and the patient requires regular follow-up, including surveillance endoscopy every two to three years.
Barrett's esophagus may or may not become cancerous over time which is why regular follow-up endoscopy is important. Upper endoscopy also is used in the diagnosis of cancer and can be used to biopsy lesions or tumors for pathology confirmation.
The esophageal pH acidity test helps in the diagnosis of GERD, when there is regular backflow of stomach acid into the esophagus. The esophageal manometry test also helps in the diagnosis of GERD, showing that weak sphincter muscles may be the cause of the condition.
Treatment
Treatment of disorders of the esophagus may include over-the-counter or prescription medicines and dietary changes to help relieve symptoms. Henry Ford Gastroenterology utilizes advanced therapeutic endoscopy procedures which allow treatment to be done at the same time certain conditions are diagnosed during the endoscopy procedure. For example, for patients with spastic disorders of the esophagus, botulinum toxin can be injected to reduce the spasms and relieve the pain. For patients with narrowing of the esophagus, therapeutic endoscopy may involve the insertion of a balloon-type device to help dilate and stretch the sphincter muscle, which may help to avoid surgery. For cancers of the esophagus, endoscopy is used to biopsy tissue and/or to remove the abnormal growths or lesions.
When medical management and/or therapeutic endoscopy procedures do not resolve the patient's painful symptoms, surgical options can be discussed. The Henry Ford Division of Gastroenterology works closely with General Surgery and the Cancer Center in the care of patients with esophageal cancer or conditions requiring surgery.
