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Oesophagus Care

  • Achalasia

    What is achalasia?
    The esophagus is the tube that carries food from the throat to the stomach. Achalasia is a serious condition that affects your esophagus. The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus. This condition can be related to damaged nerves in your esophagus. It can also be due to damage of the LES.

    What causes achalasia?
    This condition may be hereditary, or it may be the result of an autoimmune condition. With this type of condition, your body’s immune system mistakenly attacks healthy cells in your body. The degeneration of nerves in your esophagus often contributes to the advanced symptoms of achalasia. Other conditions can cause symptoms similar to achalasia. Cancer of the oesophagus is one of these conditions.

    Who is at risk for achalasia?
    Achalasia usually occurs later in life, but it can also occur in children. Individuals who are middle-aged and older are at higher risk for the condition. Achalasia is also more common in people with autoimmune disorders.

    What are the symptoms of achalasia?
    People with achalasia will often have trouble swallowing or feel like food is stuck in their esophagus. This is also known as dysphagia.This symptom can cause coughing and raise the risk of aspiration or choking on food. Other symptoms include: pain or discomfort in your chest, weight loss, heartburn and intense pain or discomfort after eating. You might also have regurgitation or backflow.

    How is achalasia diagnosed?
    Your doctor might suspect you have achalasia if you have trouble swallowing both solids and liquids, particularly if it gets worse over time.Your doctor may use oesophageal manometry to diagnose achalasia. An X-ray or similar exam of your esophagus may also be helpful in diagnosing this condition. Other doctors prefer to perform an endoscopy. Another diagnostic method is a barium swallow.

    How is achalasia treated?
    Most achalasia treatments involve your LES. Several types of treatment can either temporarily reduce your symptoms or permanently alter the function of the valve. As a first-line therapy, your doctors can either dilate the sphincter or alter it. This stretches out the sphincter and helps your esophagus function better. Esophagomyotomy is a type of surgery that can help you if you have achalasia. Your doctor will use a large or small incision to access the sphincter and carefully alter it to allow better flow into the stomach.
    If these options aren’t available, nitrates or calcium channel blockers can help relax the sphincter so food can pass through it more easily.

    What is the long-term outlook?
    The outlook for this condition varies. Your symptoms might be mild, or they may be severe. Treatment can be highly successful. Multiple treatments are sometimes necessary. Surgery may be recommended if a dilation procedure doesn’t work the first time. Usually, the chance of success decreases with each dilation. Almost 95% of people who have surgery get some relief from symptoms.

  • Barrets Oesophagus

    What is Barrett’s esophagus?
    Barrett’s esophagus is a condition in which the cells that make up your esophagus begin to look like the cells that make up your intestines. This often happens when cells are damaged by exposure to acid from the stomach.This condition often develops after years of experiencing gastroesophageal reflux (GERD). In some cases, Barrett’s esophagus can develop into esophageal cancer.

    What causes Barrett’s esophagus?
    The exact cause of Barrett’s esophagus is not yet known. However, the condition is most often seen in people with GERD. GERD occurs when the muscles at the bottom of the esophagus do not work properly. The weakened muscles won’t prevent food and acid from coming back up into the esophagus. Approximately 5 to 10 percent of people with GERD develop Barrett’s esophagus. It affects men almost twice as often as women and is usually diagnosed after the age of 55. Over time, the cells of the esophageal lining may develop into precancerous cells. These cells may then change into cancerous cells. It’s estimated that only about 0.5% of people with Barrett’s esophagus develop cancer.

    What are the risk factors?
    If you have GERD symptoms for longer than 10 years, you have an increased risk of developing Barrett’s esophagus. Other risk factors for developing Barrett’s esophagus include: being male, over 50 years, H pylori gastritis, smoking and obesity.

    Symptoms of Barrett’s esophagus
    Barrett’s esophagus does not have any symptoms. However, because most people with this condition also have GERD, they will usually experience frequent heartburn. Call your doctor right away if any of the following symptoms occur: chest pains, vomiting blood, difficulty swallowing or passing black or bloody stools.

    Diagnosing and classifying Barrett’s esophagus
    If your doctor suspects that you have Barrett’s esophagus they may order an endoscopy. An endoscope allows your doctor to see the inside of your esophagus. Your doctor may also take a tissue sample to check for dysplasia, or the development of abnormal cells.

    Treatment options for Barrett’s esophagus
    Treatment for Barrett’s esophagus depends on what level of dysplasia your doctor determines you have. Medications to treat GERD include H2-receptor antagonists and proton pump inhibitors.You may also be a candidate for surgeries that can help you manage your GERD symptoms. Your doctor may recommend more invasive procedures if you have high-grade dysplasia. For example, removing damaged areas of the esophagus through the use of endoscopy.

    What is the outlook for Barrett’s esophagus?
    Barrett’s esophagus raises your risk for developing esophageal cancer. However, many people with this condition never develop cancer. Your plan may include making lifestyle changes such as quitting smoking, limiting alcohol consumption, and avoiding spicy foods. You may also start eating smaller meals low in saturated fats, waiting at least 4 hours after eating to lie down, and elevating the head of your bed.
    All of these measures will decrease gastroesophageal reflux. You also may be prescribed H2-receptor antagonists or proton pump inhibitors. It’s also important to schedule frequent follow-up appointments with your doctor so they can monitor the lining of your esophagus. This will make it more likely that your doctor will discover cancerous cells in the early stages.

  • Oesophageal Varices

    Symptoms:
    Esophageal varices usually don’t cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:
    • Vomiting and seeing significant amounts of blood in your vomit
    • Black, tarry or bloody stools
    • Lightheadedness
    • Loss of consciousness (in severe case)

    When to see a doctor:
    Make an appointment with your doctor if you have signs or symptoms that worry you. If you’ve been diagnosed with liver disease, ask your doctor about your risk of esophageal varices and how you can reduce your risk of these complications. Ask your doctor about an endoscopy procedure to check for esophageal varices. If you’ve been diagnosed with esophageal varices, your doctor is likely to instruct you to watch for signs of bleeding.
    Bleeding esophageal varices are an emergency.

    Causes:
    Esophageal varices sometimes form when blood flow to your liver is blocked, most often by scar tissue in the liver caused by liver disease. The blood flow begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. This pressure (portal hypertension) forces the blood to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed.

    Causes of esophageal varices include:
    • Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis.
    • Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices.
    • A parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and Southeast Asia. The parasite can damage the liver, as well as the lungs, intestine and bladder

    Risk factors
    Although many people with advanced liver disease develop esophageal varices, most won’t have bleeding. Varices are more likely to bleed if you have:
    High portal vein pressure: The risk of bleeding increases with the amount of pressure in the portal vein (portal hypertension).
    Large varices: The larger the varices, the more likely they are to bleed.
    Red marks on the varices: When viewed through an endoscope passed down your throat, some varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
    Severe cirrhosis or liver failure: Most often, the more severe your liver disease, the more likely varices are to bleed.
    Continued alcohol use: Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.

    Complications
    The most serious complication of esophageal varices is bleeding. Once you have had a bleeding episode, your risk of another bleeding episode greatly increases. If you lose enough blood, you can go into shock, which can lead to death.

  • Oesophagitis

    Esophagitis is defined as inflammation of the esophagus, which is the tube that connects the throat to the stomach.Esophagitis can be caused by infection, irritation of the esophagus, or inflammation of the lining of the esophagus. There are several types of esophagitis: reflux esophagitis, infectious esophagitis, Barrett’s esophagus, eosinophilic esophagitis, Behçet’s syndrome (also called Behçet’s disease), graft-versus-host disease, and cancer esophagitis.

    Causes of esophagitis:
    Esophagitis can be caused by infection or irritation of the esophagus. Infections of the esophagus can be caused by bacteria, viruses, or fungi. One of the main causes of esophageal irritation is reflux of stomach acid. There are several causes for reflux:
    Signs and symptoms of esophagitis include:
    • difficult and/or painful swallowing,
    • feeling of food getting stuck on the way down.
    • acid reflux, unpleasant taste in mouth, sore throat, hoarseness, cough, mouth sores.
    • nausea, vomiting, abdominal pain, Indigestion, chest pain and bad breath

    Diagnosis of esophagitis:
    • Endoscopy (gastroscopy)is the best way to diagnose oesophagitis.

    Treatment:
    Treatment for esophagitis depends on its cause. It may be treated with medications, endoscopy, stretching of the esophagus, surgery, and lifestyle changes. Diet can often help reduce symptoms of esophagitis. The GERD diet is aimed at reducing acid reflux, the main cause of esophagitis. Lifestyle changes that may alleviate symptoms of GERD and esophagitis include:
    • stop smoking
    • Remain upright while eating and for a time (about 2-3 hours) afterwards
    • Take small bites and chew food slowly
    • Avoid eating within 3 hours of bedtime or laying down
    • Raise the head of the bed by 4 to 6 inches (put blocks or a foam wedge under the head of the bed; don’t use pillows as this can put pressure on the abdomen)
    • Lose weight.
    • Wear loose clothing.
    • Avoid aspirin or ibuprofen.

    Complications of esophagitis:
    Bleeding, ulcers, chronic scarring, difficult or painful swallowing, and malnutrition. Barrett’s esophagus is a complication that increases the risk of esophageal cancer.

    Prognosis:
    The prognosis for esophagitis depends on the underlying cause. Esophagitis caused by infection or inflammation is generally treatable and most people can recover fully Esophagitis caused by reflux can recur frequently. Many people with GERD develop Barrett’s esophagus, which increases the risk for cancer. Achalasia is progressive, but treatable.

  • Oesophageal Cancer

    Oesophageal cancer is a type of cancer affecting the oesophagus (gullet) – the long tube that carries food from the throat to the stomach.It mainly affects people in their 60s and 70s and is more common in men than women.

    Symptoms of oesophageal cancer:
    Oesophageal cancer doesn’t usually cause any symptoms in the early stages when the tumour is small. It’s only when it gets bigger that symptoms tend to develop.

    Symptoms of oesophageal cancer can include:
    • difficulty in swallowing.
    • persistent indigestion or heartburn.
    • bringing up food soon after eating
    • loss of appetite and weight loss.
    • pain or discomfort in your upper tummy, chest or back

    When to get medical advice
    See your DR if you experience:
    • swallowing difficulties
    • heartburn on most days for three weeks or more
    • any other unusual or persistent symptoms
    The symptoms can be caused by several conditions and in many cases won’t be caused by cancer – but it’s a good idea to get them checked out.

    Causes of oesophageal cancer
    The exact cause of oesophageal cancer is unknown, but the following things can increase your risk:
    • persistent Gastroesophgeal reflux diseases (GORD)
    • smoking
    • drinking too much alcohol over a long period of time
    • being overweight or obese
    • having an unhealthy diet that’s low in fruit and vegetables
    Stopping smoking, cutting down on alcohol, losing weight and having a healthy diet may help reduce your risk of developing oesophageal cancer.

    Treatments for oesophageal cancer
    If oesophageal cancer is diagnosed at an early stage, it may be possible to cure it with:
    • surgery to remove the affected section of oesophagus
    • chemotherapy, with or without radiotherapy (chemoradiation), to kill the cancerous cells and shrink the tumour.
    If oesophageal cancer is diagnosed at a later stage, a cure may not be achievable. But in these cases, surgery, chemotherapy and radiotherapy can be used to help keep the cancer under control and relieve any symptoms you have.

    Prognosis for oesophageal cancer:
    The prognsis for oesophageal cancer varies depending on things such as how far it has spread, your age and your general health.If it’s detected while it’s still quite small, it may be possible to get rid of it completely. But as oesophageal cancer doesn’t usually cause any symptoms until a late stage, it has often spread quite far by the time it’s diagnosed.

  • GORD/Heartburn

    Laparoscopic Anti-Reflux (GERD) Surgery/Surgery for Heartburn:
    If you suffer from moderate to severe “heartburn” your surgeon may have recommended Laparoscopic Antireflux Surgery to treat this condition, technically referred to as gastroesophageal reflux disease (GERD).

    What is Gastroesophageal Reflux Disease (GORD):
    Although “heartburn” is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or “back up” from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck. The feeling may radiate through the chest and into the throat and neck. Other symptoms may also include vomiting or regurgitation, difficulty swallowing and chronic coughing or wheezing.

    What Causes GERD?
    When you eat, food travels from your mouth to your stomach through a tube called the esophagus. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices, which have a high acid content, into the esophagus. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus. A few patients may develop a condition in which there is a change in the type of cells in the lining of the lower esophagus, called Barrett’s esophagus. This is important because having this condition increases the risk of developing cancer of the esophagus.

    What Contributes to GERD?
    Some people are born with a naturally weak sphincter (LES). For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LES to relax, causing reflux. A hiatal hernia is found in many patients who suffer from GERD. This refers to the condition in which the top part of the stomach bulges above the diaphragm and into the chest cavity. This phenomenon is thought to contribute to the development of acid reflux. Surgery for GERD also fixes the hiatal hernia.

    GERD is generally treated in three progressive steps:
    1. Life style Changes:
    In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing or eliminating smoking and alcohol consumption, and altering eating and sleeping patterns can also help.
    2. Drug therapy:
    If symptoms persist after these life style changes, drug therapy may be required. Antacids neutralize stomach acids and over-the-counter medications reduce the amount of stomach acid produced.
    3. SURGERY
    Patients who do not respond well to lifestyle changes or medications or those who do not wish to continually require medications to control their symptoms, may consider undergoing a surgical procedure. Surgery is very effective in treating GERD. The most commonly performed operation for GERD is called a fundoplication