Esophageal Conditions and Treatments

What is the esophagus?

The esophagus is a muscular tube connecting the throat with the stomach. It is approximately eight inches long and lined with moist pink tissue known as mucosa. The esophagus runs behind the trachea (windpipe) and heart and in front of the spine and passes through the diaphragm just before entering the stomach.

What are some common esophageal conditions?

Common problems with the esophagus include:

• Heartburn: This occurs when acidic stomach contents back up (reflux) into the esophagus.
• Gastroesophageal reflux disease (GERD): A person suffers from this condition when reflux occurs frequently.
• Esophagitis: This involves inflammation of the esophagus that may be due to irritation or infection.
• Barrett’s esophagus: Regular reflux (stomach acid) irritates the esophagus, causing the lower portion to change its structure.
• Esophageal ulcer: This is an erosion in an area of the esophagus lining, often caused by chronic reflux.
• Esophageal stricture: This involves a narrowing of the esophagus, usually caused by chronic irritation from reflux. If the esophagus becomes too narrow, it can lead to difficulty swallowing.
• Mallory-Weiss tear: Vomiting or retching can cause a tear in the lining of the esophagus, which bleeds into the stomach. This is often followed by vomiting blood.

What is gastroparesis and how does it affect the esophagus?

Gastroparesis is a condition affecting the spontaneous movement of the muscles in the stomach. Normally, food is propelled through the digestive tract by strong muscular contractions. With gastroparesis, this movement is slowed down or does not occur at all, which prevents the stomach from emptying properly.

The delay in gastric emptying associated with gastroparesis can lead to prolonged retention of food that may have a propensity to reflux. The food that remains in the stomach causes an increase in pressure and gastric acid secretion, which can lead to gastroesophageal reflux disease (GERD), a condition that develops with frequent reflux.

Treatment for gastroparesis

Our Atlanta gastroparesis treatment may include:

• Dietary changes, including eating small, frequent meals and chewing food thoroughly
• Medications to stimulate the stomach muscles and control nausea and vomiting
• Surgical treatment, which may involve placing a feeding tube in the small intestine, or a gastric venting tube to help relieve pressure from gastric contents

What is achalasia?

Achalasia is a serious condition affecting the esophagus. The lower esophageal sphincter (LES) is the muscular ring that closes off the esophagus from the stomach and should open when you swallow. With achalasia, the LES fails to open, leading to a backup of food within the esophagus, and making it difficult for foods or liquids to pass into the stomach. This occurs when the nerves in the esophagus become damaged. The esophagus loses its ability to squeeze food downward, and the LES fails to fully relax. There is no cure for achalasia. Symptoms can be managed with minimally-invasive therapy or surgery.

Peroral endoscopic myotomy (POEM) surgery to treat achalasia

Peroral endoscopic myotomy (POEM) is a newer technique for managing achalasia. It is an endoscopic, in-patient procedure that can take one to three hours to perform. An endoscope (a slender, tubular, flexible medical device with a light and camera attached) can be passed through the mouth or the rectum, allowing the surgeon to examine surfaces of the esophagus, stomach, intestine, and colon, without making large incisions.

What can you expect with POEM surgery?

POEM surgery is performed to relieve tightness and allow the esophagus to empty normally to pass food into the stomach.

• You will be on a liquid diet for two days prior to the surgery and not allowed to eat or drink anything for 12 hours before the procedure. This helps keep your stomach and esophagus clear so the endoscope can pass.
• The procedure is performed under general anesthesia.
• An endoscope tube is inserted into your mouth and down your esophagus. The surgeon is able to control the endoscope by watching a TV monitor connected to a small camera on the end of the tube.
• The endoscope tube tunnels into the lining of the esophagus muscles, creating a pathway.
• A knife cuts away and loosens tight esophagus muscles causing swallowing problems, including muscles on the side of the esophagus, the lower esophagus sphincter (LES), and the upper part of the stomach.
• Once this process is complete, endoscopic clips are inserted at the lining of the esophagus to keep the incision at the top closed.
• The endoscope tube is removed through the mouth.

What is recovery like after POEM surgery?

You will likely remain in the hospital overnight to ensure there are no complications after your peroral endoscopic myotomy. You will not be allowed to eat anything after the procedure. The morning after POEM surgery, you will have a barium X-ray to ensure the esophagus muscle is open and there is no leakage. You will be started on a liquid diet and discharged from the hospital the same day. Ten days after surgery, you will see your surgeon on ans outpatient basis. After three months, you will need to come in for a swallow study to ensure your esophagus is emptying well. At IBI, we have among the best esophageal surgeons in Atlanta. Contact us to discuss treatment options if you are suffering from achalasia or another esophageal condition.