Oesophageal diseases, causes & symptoms.
There are several different oesophageal diseases that can affect the oesophagus, including cancer, achalasia and GORD. Read more about them here.
Gastro Oesophageal Reflux Disease (GORD)
The oesophageal disease GORD is one of most common GI tract conditions, where acid from the stomach repeatedly leaks up into the oesophagus causing inflammation. It usually occurs as a result of the lower oesophageal sphincter becoming weakened.
There are several causes associated with GORD, the main ones being diet & lifestyle. Factors which can aggravate acid reflux include:
- Eating large meals or eating late at night
- Eating certain foods (triggers) such as fatty or fried foods
- Drinking certain beverages such as alcohol or coffee
- Taking certain medications such as aspirin and ibuprofen
- Certain conditions can also increase the risk of GORD, namely, obesity, hiatal hernia, pregnancy and delayed stomach emptying
Over time, chronic inflammation of the oesophagus caused by GORD can cause:
- Narrowing of the oesophagus (oesophageal stricture) – Damage to the lower oesophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
- An open sore in the oesophagus (oesophageal ulcer) – Stomach acid can wear away tissue in the oesophagus, causing an open sore to form. An oesophageal ulcer can bleed, cause pain and make swallowing difficult.
- Precancerous changes to the oesophagus (Barrett’s Oesophagus). Damage from acid can cause changes in the squamous epithelium lining the lower oesophagus. These changes are associated with an increased risk of oesophageal cancer. Minimal damage is known as low-grade dysplasia & significant damage is known as high-grade dysplasia.
Symptoms of GORD can be mild or severe but they usually become more severe when the condition has gone untreated for a long period of time. These symptoms may include:
- Acid reflux
- A sore, inflamed oesophagus (oesophagitis)
- Bad breath
- Bloating and belching
- Feeling or being sick
- Pain when swallowing (odynophagia) and/or difficulty swallowing (dysphagia)
Oesophageal Diseases – Achalasia
Achalasia is a serious condition where failure of oesophageal peristalsis causes impaired relaxation of the lower oesophageal sphincter, resulting in a backup of food that can cause the oesophagus to dilate. This condition can be related to damaged nerves in the oesophagus or it can also be due to damage of the lower oesophageal sphincter.
People with achalasia often have dysphagia or feel like food is stuck in their oesophagus. This symptom can cause coughing and raise the risk of aspiration or inhaling / choking on food. Other symptoms include:
- Pain or discomfort in the chest
- Weight loss
- Intense pain or discomfort after eating
However, other conditions such as GORD and Cancer of the oesophagus can also cause symptoms like achalasia.
Oesophageal perforation is a rupture of the oesophagus. If the rupture occurs in the upper third of the oesophagus, symptoms might include:
- Swelling of the neck
- Continuous pain that extends from the chest to the back
If it occurs in the chest, there may be:
- Upper abdominal pain
- Shortness of breath (dyspnoea)
- Severe chest pain
Perforations can be caused by:
- Abdominal trauma
- Ingesting sharp, elongated foreign bodies such as fish bones
- Swallowing caustic substances
- A secondary complication to oesophagitis or peptic ulcers
- Abnormal tissue growth (neoplasm).
Instrumental damage from diagnostic medical procedures such as endoscopy or gastroscopy. This is the most common cause of oesophageal perforation.
Another cause of oesophageal perforation is severe, protracted vomiting resulting in a partial or full-thickness tear in the lower part of the oesophagus, most commonly at the GOJ.
A partial, longitudinal tear or laceration of the mucosa is known as Mallory Weiss Syndrome. A partial tear may result in severe bleeding from the GI tract.
A full-thickness rupture of the oesophagus is known as Boerhaave’s Syndrome. People with this disorder may have severe stomach and chest pain, shortness of breath, rapid heartbeat (tachycardia), a blue discoloration of the skin (cyanosis) and eventually circulatory failure due to the loss of blood (shock) through the oesophagus.
Oesophageal Varices are dilated, enlarged, and tortuous veins, arteries or lymphatic vessels at the lower end of the oesophagus caused as a result of hypertension in the portal vein of the liver; they are superficial and prone to rupture and massive bleeding.
Oesophageal webs or rings are thin, membranous folds of tissue that form in the oesophagus. Clinicians may use both “webs” and “rings” to refer to the same structure. These structures make the oesophagus narrower, blocking it fully or partially.
A Schatzki ring is a circular band of mucosal tissue that can form at the end of the oesophagus closest to the stomach. The ring of tissue causes the oesophagus to narrow. When a ring forms, a person may have no symptoms, or they may have dysphagia.
The cause of oesophageal webs and rings is unknown. Several factors may be involved. Some oesophageal webs are inherited or passed down genetically from parents to children. Others are thought to be associated with iron deficiencies, developmental abnormalities, inflammation, or autoimmune disorders.
Oesophageal cancer is becoming a much more common oesophageal disease in the UK with 9,210 cases diagnosed in 2015. Cancer can occur in any part of the oesophagus, from the back of the throat to the top of the stomach. There are two main types of oesophageal cancer:
- Squamous cell carcinoma – found in the cells that line the upper part of the oesophagus and makes up about a third of cases of oesophageal cancer in the UK
- Adenocarcinoma – develops in cells that make mucus and other fluids in lower part of the oesophagus. Adenocarcinoma has increased in the last 20 years, making up about two-thirds of cases of oesophageal cancer in the UK.
Although there may be no symptoms in the early stages, as the cancer develops, patients may experience symptoms such as:
- Weight loss
- Hoarse voice
- Enlarged lymph nodes around the collarbone
- Vomiting blood (haematemesis)
- Stomach ‘problems’
Older people in their 60s & 70s are much more susceptible to oesophageal cancer. It is also 7 times more prevalent in men than women. Roughly 10% of patients with Barratt’s Oesophagus will develop adenocarcinoma from the Barratt epithelium.
Other risk factors for developing oesophageal cancer are thought to be related to:
- Diets high in processed meat and low in fruit & veg
All these things also increase likelihood of patients suffering from GORD & therefore increased risk of developing Barrett’s Oesophagus, which as mentioned above is a precursor to cancer.
Cancer is staged according to how developed it is, the most common method for staging oesophageal cancer is the TMN system. Using this system, cancer is scored in 3 categories:
- T – tumour – location and size of the primary tumour
- N –node – has cancer spread to lymph nodes?
- M – metastasis – has cancer spread to other parts (e.g. lung, liver, bones)? This will help to determine the treatment.