American Medical Association Family Medical Guide - American Medical Association [487]
WARNING!
Food Caught in the Esophagus
In severe cases, food can get stuck in a narrowed esophagus. Because you could inhale it into your lungs, which can be fatal, the food must be removed. If you are choking or you think you may have food stuck in your esophagus, call 911 or your local emergency number or have someone call for you or take you to the nearest hospital emergency department.
Achalasia
Achalasia is a rare disorder of unknown cause in which the muscle segment between the esophagus and stomach fails to relax after swallowing to permit food to enter the stomach. As a result, food accumulates in the lower part of the esophagus. Eventually other sections of the esophagus muscle are also affected, and the contractions that move food through the esophagus become irregular and uncoordinated. In some cases, as achalasia worsens, a person may inhale food particles (especially while sleeping), which can lead to pneumonia (see page 660).
Symptoms
The main symptom of achalasia is regurgitating food a day or two after eating it. As food accumulates in your esophagus, you may feel discomfort or pain in your chest and have an unpleasant taste in your mouth along with bad breath. At first you will only have difficulty swallowing food, but eventually you will also have trouble swallowing liquids. Because food does not pass into your intestines to be absorbed, you may lose weight and have symptoms of vitamin or mineral deficiencies.
Diagnosis
If you have symptoms of achalasia, your doctor will probably perform a procedure called endoscopy (see page 766) to examine your esophagus to rule out a tumor. Your doctor may also recommend a barium X-ray (see page 767) of your esophagus. Achalasia can be confirmed with a procedure called manometry (see previous page), which measures pressure inside the esophagus to evaluate its contractions. If manometry shows that the muscle at the bottom of your esophagus fails to relax, you have achalasia.
Treatment
To treat achalasia, your doctor will probably refer you to a gastroenterologist (a doctor who specializes in disorders of the digestive system). The gastroenterologist will insert a flexible viewing tube (endoscope) into the esophagus and pass a deflated bag or balloon that can be filled with air or water through the endoscope. When the bag is inflated, it stretches the muscles at the bottom of the esophagus, expanding the opening enough to allow food to pass into the stomach more easily. This procedure carries a risk of perforating the esophagus and usually must be repeated. In some cases, a surgeon will cut some of the muscles at the stomach entrance to open a passageway for food. Although this surgery is sometimes effective, it can increase the risk of gastroesophageal reflux disease (GERD; see page 750).
Esophageal Varices
Esophageal varices are bulging (varicose) veins in the lower part of the esophagus (and sometimes the upper part of the stomach) that usually result from elevated blood pressure in the portal vein, the vein that carries blood from the stomach and intestines to the liver. The increased pressure in the portal vein usually is caused by scarring of the liver from cirrhosis (see page 790). People who have liver damage from uncontrolled hereditary hemochromatosis (see page 961) or a disease such as Wilson’s disease (see page 792) are also at increased risk of developing esophageal varices. The veins can widen to the point of rupture, causing bleeding into the esophagus or stomach, which can be fatal.
Symptoms
Symptoms of bleeding from esophageal varices include vomiting blood and passing dark-colored or black stool. The stool