Achalasia is a disorder characterized by a loss of peristalsis (propulsive muscle contractions or movement) in the esophagus and failure of the lower esophageal sphincter to relax and allow emptying of the esophagus. Symptoms include consistent difficulty swallowing (dysphagia), and food sticking or a heavy sensation in the chest. Trapped food in the esophagus may be regurgitated.
The cause of achalasia is unknown (idiopathic). There is a loss of nerve cells in the Auerbach plexus between the two muscle layers of the esophageal wall and in the lower esophageal sphincter. This defect results in the loss of peristalsis, which is needed to push food into the stomach, and failure of the lower esophageal sphincter to relax and allow food to enter the stomach. These changes result in failure of esophageal emptying and retention of solid and liquid foods in the esophagus. Over time the esophagus enlarges and holds more and more contents.
For more information on achalasia click the following link to Swallowing News. 2003 Jun. Vol.15 No.1
The medical dictionary defines aphagia as the refusal or loss of ability to swallow. To read about several causes and treatment options for this tragic medical condition, including Endoscopic Lumen Restoration (ELR) please click the following link.2006 Nov. Vol. 18 No.2.
Esophageal Cancer has been recognized for thousands of years. Over two thousand years ago in China it was referred to as Ye Ge, which literally means difficult swallowing (dysphagia) and belching. Symptoms of esophageal cancer include difficulty swallowing (dysphagia), food sticking in the esophagus, weightloss, painful swallowing (odynophagia) and regurgitaion of undigested food.
Until the past two decades, the term esophageal cancer was synonymous with squamous cell carcinoma (a malignant neoplasm derived from stratified squamous epithelium). However, in the twenty first century, this imbalance favoring squamous cancer over primary adenocarcinoma (a malignant neoplasm of epithelial cells forming glandular structures) of the esophagus in the United States has changed drastically. During the past two decades there has been a ten-fold increase in adenocarcinoma of the esophagus. The dramatic increase is occurring primarily in white males in the fourty to seventy year age range in association with columnar-lined (Barrett) esophagus.
To read more about esophageal cancer in Swallowing News please click the following articles.Esophageal Malignancies and Premalignant Conditions: A Remarkable Evolution - Part I Esophageal Malignancies and Premalignant Conditions: A Remarkable Evolution - Part II
Palliation for Cancer: Esophageal StentsFor more information from Swallowing News click here.
The use of the medical term diverticulum (plural: diverticula) implies an abnormal pouch or sac along a tubular organ created by a defect in the muscular coat of that organ. Symptoms include difficulty swallowing (dysphagia), bad breath (halitosis) food regurgitation while bending or lying down. Nocturnal regurgitation may cause pneumonia.
Zenker's Diverticulum, a pouch that arises from the posterior hypopharynx pharynx that commonly results in swallowing difficulty, is discussed in the Swallowing News article by Dr. Umesh Choudhry.
Click the following link and scroll to page 4 to view this article.1997 Nov. Vol.9 No.2
Literally translated, dysphagia represents a combination of "dys" (a prefix from Greek meaning bad, difficult or disordered) and "phagia" (a Greek word element that means eating or swallowing). The sensation of dysphagia, a delay or difficulty with passage of solids or liquids, always occurs within ten seconds of the onset of a swallow. It is never psycogenic, i.e. it is not something "from your mind or not real". The medical history, observation of swallowing, and timing the onset of dysphagia are exceedingly reliable for diagnosis and will be accurate in from 80 to 90 percent of instances, as to the mechanism involved, its location, and whether the cause is malignant. Whatever the etiology or level of the dysfunction or obstruction, the physician is fortunate because the medical history is so accurate in determining the type and location of the problem. If the physician listens to the patient's description of the problem and asks the appropriate questions, the diagnosis usually will be apparent.
To read more about dysphagia please see the Swallowing News article Dysphagia - Difficulty Swallowing.
Esophageal injury due to "pills" was first reported in 1970 by Pemberton, but is little known among primary care physicians and many specialists. The most common symtom is a burning sensation in the chest. In most cases not enough water is consumed to flush the pill down the esophagus or there may be a stricture causing the hang up. Inflammation of the mucosal lining occurs over repeated exposure to the pill and swallowing may be painful.
Esophagitis (inflammation of the esophagus) due to acid reflux always involves the squamocolumnar junction (i.e. junction of esophageal mucosa with stomach or gastric mucosa) at some point in its circumference. Although so-called stepping stone erosions may be seen proximal to the main squamocolumnar junction, they will always be associated with other endoscopic signs of mucosal injury at the squamocolumnar junction. When one sees esophagitis proximal to a normal squamocolumnar junction, an immediate suspicion for other etiologies should arise.
To read more about some medications causing drug-induced "pill" esophagitis, a potentially lethal disorder, please click the following link. 2006 May Vol.18 No.1
Further information can be found in the following 2 Swallowing News articles."Pill Esophagitis" - Esophageal Injury Caused by Drugs Part I "Pill Esophagitis" - Esophageal Injury Caused by Drugs Part II
Eosinophils are the cells that respond to contact with substances that produce an allergic response in patients who are sensitive. Eosinophilic esophagitis is a new entity characterized by eosinophils in the esophagus and sometimes associated with ringed strictures at any level of the esophagus usually in the mid esophagus. Symptoms in children include vomiting, regurgitation, abdominal pain, dysphagia, solid food sitophobia. Adults experience dysphagia, food impactions, gastroesophageal reflux disease symptoms (with or with out heartburn), vague high epigastric pain/chest pain, nausea, vomiting, solid food sitophobia, and a history of slow eating since childhood. Patients with eosinophilic esophagitis are usually white males of any age and typically present to our clinic under the age of 40.
Eosinophilic esophagitis patients are treated in a variety of ways. When an allergy is food specific, food elimination diets are effective. Also, elemental (amino acid) diets, although not palatable for most persons, have seen excellent success for patients with food specific allergies. Systemic and topical steroids are also being used for treatment in patients with no specific food allergy. Proton Pump Inhibitors are used as adjuvant therapy since some patients also suffer from acid reflux disease (GERD). Follow-up with repeat endoscopies and repeat biopsies should continue even after resolution of symptoms. Some patients develop strictures that require dilation therapy.
Gastroesophageal Reflux Disease (GERD)
A hiatal hernia is characterized by part of the stomach protruding through the hiatus, (opening in the diaphragm), and is one of the most prevalent defects of the gastrointestinal tract in the Western world. Although a few instances are congenital, hiatal hernias usually appear later in life and are considered to be acquired. Possible causes include esophageal contraction or shortening secondary to acid reflux-induced injury with pulling-up of the stomach, increased intraabdominal pressure pushing the stomach above the diaphragm, atrophy or weakening of the hiatal region and supporting tissue (phrenoesophageal membrane) and combination of these factors. Hiatal hernia by itself is not associated with any symptoms.
To read more about hiatal hernia in Swallowing News please click the following articles.Diaphragmatic Hiatal Hernia and The Myth and Challenge of the Hiatal Hernia (scroll down to page 2).
Approximately 75 milliion Americans are expected to have experience non-cardiac chest pain (NCCP) at any point in time. Most of these patients go to their primary care provider, who in turn, refer them for a complete cardiac evaluation. Among the estimated 600,000 who undergo a cardiac catheterization every year, approximately 30% or 180,000 have no significant coronary artery disease and thus are said to have NCCP. Among these patients, approximately half or 90,000 may have chest pain attributable to the esophagus.
To read more about NCCP in Swallowing News please click the following link and scroll down to page 3.Non-Cardiac Chest Pain: Diagnostic Dilemmas and Therapy
Sialorrhea or ptyalism is an excessive salivary flow leading to a common patient complaint of, "I have a lot of foamy mucus in my mouth!" Sialorrhea occurs with conditions that promote an increase in saliva secretion and/or disturb its passage through the esophagus into the stomach. Within the oral cavity, three major salivary glands (parotid, submandibular, and sublingual) as well as several minor glands produce more than a quart of saliva each day.
To read more of Dr. Michael Bakheet's article in Swallowing News on sialorrhea click the following link and scroll down to page 2. 2003 Jun. Vol.15 No.1
The most common cause of difficulty swallowing (dysphagia) is esophageal stricture or narrowing due to acid injury to the lower esophagus at the point the esophagus joins the stomach. Symptoms, in addition to dysphagia, include a feeling of food sticking in the esophagus, regurgitation of food, and weight loss.
To learn about the causes and treatment of esophageal stricture please click the following link to Swallowing News:Esophageal Stricture