Esophagus Disorders

The esophagus is the second part of the digestive tract, following the mouth and preceding the stomach. It is a tube that propels food down to the stomach, via rhythmic wave-like contractions called peristalsis.

There are many esophageal disorders, but most have two particular symptoms. The first symptom is general chest or back pain. The second symptom is a difficulty in swallowing, called dysphagia. Esophageal disorders can be caused by an injury or an [Page 624]obstruction, or esophageal bleeding or cancer. Other disorders may affect peristalsis; these disorders are called propulsion-related esophagus disorders.

In order to keep oral and gastric contents out of the esophagus while a person is not swallowing, the esophagus is flanked by two muscular sphincters. As a normal part of aging, these sphincters become weaker and sometimes cannot keep acidic stomach contents from entering the esophagus. This condition is called presbyesophagus, with the prefix ‘presby’ signifying the condition's relationship to old age. Some younger people experience periodic gastric acid reflux, another example of the acidic stomach chyme entering the esophagus abnormally. The healthy esophagus is protected by a thick layer of tough cells which line the esophagus. These epithelial cells are of the squamous cell type. A person with chronic acid reflux may have a weakened or damaged esophageal lining. People suffering from bulimia who force themselves to vomit also damage their esophageal lining.

Any cell population that is continuously replenishing itself and therefore undergoing genetic replication is at an elevated risk for developing cancer. The continuous genetic replication cycles can promote a mutation that might otherwise be inconsequential. Forced vomiting or acid reflux disease, add undo stress to the cells lining the esophagus, leading to an enhanced rate of cellular division while the esophagus tries to repair itself. This enhanced division rate also increases the risk of developing esophageal cancer.

Esophageal cancer begins in the innermost cell layer lining the esophagus. In the past, esophageal cancer was difficult to treat and survival was rare. Today, a precancerous condition known as Barrett's esophagus can be recognized early, when cancer treatment is most effective. Barrett's esophagus is a result of acid reflux disease. Smoking and drinking in excess can also strain the esophagus and predispose it to cancer. Other risk factors include age above fifty-five years, male gender, being African American, being overweight, eating a diet poor in fruits and vegetables, and working in professions with exposures to certain chemicals such as dry cleaning solutions and construction materials, and other toxins or irritants such as during mining.

Crohn's disease is a chronic disorder of the digestive tract that often affects the large intestine, though it can affect the tract from the esophagus to the rectum. It is an inflammatory disorder that may be auto-immune. It may have genetic components, but often the cause is idiopathic, meaning it is unknown. The inflammation can result in pain and difficulty in eating. Crohn's patients can attempt to keep the disorder in check by following a diet regimen that avoids aggravating foods while maintaining proper nutrition, taking corticosteroids and antibiotics if necessary, and painkiller medications. A supplement of vitamin E may need to be added to the diet, as Crohn's patients may not absorb enough vitamin E from a regular diet. The disease typically inflames during periods of high stress or after exerting physical activity.

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