Dr Hunter Wang

Gastroenterologist & Interventional Endoscopist

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Oesophageal Diseases

What is the Gastrointestinal System?

The gastrointestinal tract (GI) extends from the mouth to the anus. It is divided into the following:

  • the upper, 
  • middle and 
  • lower gastrointestinal tract.


The gastrointestinal system is a long tube with specialised sections capable of digesting and extracting useful components entering the mouth and expelling waste products from the anus.

  1. Food is chewed and mixed with saliva in the mouth and swallowed. 
  2. It then enters the long, narrow oesophagus tube (food pipe), which is lined by muscles that expand and contract, pushing food into the stomach. 
  3. The stomach secretes acid and other digestive enzymes for digestion and stores food before it enters the intestine. 
  4. The duodenum is the first part of the small intestine attached to the stomach, which helps digestion.
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Upper Gastrointestinal Tract 

The upper gastrointestinal tract encompasses the 

  • mouth, 
  • oesophagus,
  • stomach, and 
  • duodenum.


What are Oesophageal Diseases?

Oesophageal diseases are medical conditions that affect the oesophagus, a muscular tube connecting the mouth to the stomach. The oesophagus plays a crucial role in digestion, helping to move food and liquid from the mouth into the stomach. Oesophageal diseases can cause various symptoms, such as difficulty swallowing, chest pain, heartburn, and regurgitation.


Common Oesophageal Diseases

There are several types of oesophageal diseases, each with symptoms and causes. Some of the most common oesophageal diseases include

  • Gastro-oesophageal Reflux Disease (GORD) is a condition in which the muscle between the oesophagus and stomach (lower oesophageal sphincter) fails to close properly, allowing stomach acid to flow back into the oesophagus. GORD can cause symptoms such as heartburn, regurgitation, difficulty swallowing, and a sour taste in the mouth.
  • Oesophagitis: This is inflammation of the lining of the oesophagus, which GORD, infections, or medications can cause. Oesophagitis can cause symptoms such as pain when swallowing, chest pain, and heartburn.
  • Barrett's Oesophagus: This is a condition where the cells in the lining of the oesophagus change and become abnormal due to chronic acid reflux. Barrett's oesophagus is a risk factor for oesophageal cancer.
  • Achalasia: This is a rare condition where the muscles in the oesophagus fail to relax, making it difficult for food to pass through into the stomach. Symptoms of achalasia include difficulty swallowing, chest pain, and regurgitation.
  • Oesophagus Cancer: This type of cancer develops in the oesophagus lining. It can cause symptoms such as difficulty swallowing, weight loss, chest pain, and fatigue.


Risk Factors and Causes of Oesophageal Diseases

Specific individuals are at higher risk for developing oesophageal diseases than others. The risk factors for oesophageal diseases may include the following:

  • Oesophageal diseases are more common in older adults.
  • Men are more likely to develop oesophageal cancer than women.
  • Certain lifestyle factors, such as smoking, excessive alcohol consumption, and a diet high in fatty or spicy foods, can increase the risk of developing oesophageal diseases.
  • Being overweight or obese can increase the risk of developing GORD and oesophageal cancer.
  • A family history of oesophageal diseases can increase the risk of developing these conditions.
  • Certain medical conditions, such as hiatal hernia, scleroderma, and achalasia, can increase the risk of developing oesophageal diseases.
  • Certain medications, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates, can increase the risk of developing oesophageal diseases.


Symptoms of Oesophageal Diseases

The symptoms of oesophageal diseases can vary depending on the type and severity of the condition. Common symptoms include

  • Difficulty swallowing: feeling like food is stuck in your throat or chest.
  • Heartburn: a burning sensation in the chest that can be triggered by eating or lying down.
  • Regurgitation: the feeling of food or liquid returning from the stomach into the throat.
  • Chest pain: discomfort or pressure in the chest that may feel like a heart attack.
  • Chronic cough: a persistent cough that doesn't go away and is not due to a cold or other infection.
  • Hoarseness: a change in your voice that may sound raspy or strained.

Diagnosis of Oesophageal Diseases

To diagnose oesophageal diseases, your doctor may recommend one or more of the following tests:

  • Endoscopy: A thin, flexible tube with a camera is inserted into the oesophagus to look for signs of inflammation, narrowing, or cancer.
  • Barium swallow: You will swallow a special liquid that coats the inside of your oesophagus and stomach. X-rays are then taken to detect any abnormalities.
  • Biopsy: A small tissue sample is taken during endoscopy and examined under a microscope to detect cancer or other abnormalities.
  • pH monitoring is a test that measures the amount of acid in your oesophagus over 24 hours to diagnose acid reflux.
  • Manometry: A test that assesses the coordinated muscle movement of the oesophagus
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Treatments for Oesophageal Diseases

Medications

Depending on the type of oesophageal disease, medications may be prescribed to reduce inflammation, decrease acid production, or treat infections. For example, proton pump inhibitors (PPIs) and H2 blockers can help reduce acid reflux and oesophagitis, while antibiotics may be used to treat infections.


Endoscopic procedures

An endoscopy can remove abnormal cells in the oesophagus or stretch a narrowed oesophagus.


Lifestyle changes

Certain lifestyle changes can help manage oesophageal diseases and prevent symptoms from occurring. For example, avoiding trigger foods, eating smaller meals, and avoiding lying down after eating can help reduce acid reflux symptoms. Quitting smoking and reducing alcohol consumption can also be helpful.


Dilatation

This procedure widens the oesophagus if it has narrowed due to scar tissue or inflammation. The procedure involves using an endoscope with a balloon or other device to stretch the oesophagus.


Surgery

In some cases, surgery may be required to treat oesophageal diseases. For example, surgery may be necessary to remove scar tissue or repair a damaged oesophagus. Surgery may also be used to treat oesophageal cancer.


What if Oesophageal Diseases are Untreated?

If oesophageal diseases are left untreated, they can lead to serious complications such as 

  • severe loss of blood, 
  • ulcers, 
  • inflammation of the upper digestive tract, 
  • pulmonary aspiration, 
  • narrowing of the oesophagus and swallowing difficulty, and 
  • may increase the risk of developing cancer. 


Barrett's oesophagus is another complication of untreated oesophageal diseases. Chronic acid reflux can damage the lining of the oesophagus, causing the cells to change and become abnormal. This can increase an individual's risk of developing oesophageal cancer.


Untreated oesophageal diseases can lead to severe complications impacting an individual's health and well-being. It's essential to seek medical attention promptly if you experience any symptoms of these conditions. Early diagnosis and treatment can help manage symptoms and prevent complications, improving your prognosis and quality of life.

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