American Medical Association Family Medical Guide - American Medical Association [489]
Diagnosis
If you have symptoms of esophageal cancer such as difficulty swallowing, your doctor will probably recommend a barium X-ray (see page 767) of your esophagus. He or she may also perform a procedure called endoscopy (see page 766) to examine your esophagus. If an abnormality is found on the X-ray or endoscopy, your doctor may also recommend a biopsy (in which samples of cells are taken from the esophagus and examined under a microscope).
Treatment
Surgery is the usual treatment for cancer of the esophagus. Radiation therapy (see page 23) and chemotherapy (see page 23) may be used alone or in combination to destroy cancer cells. Laser therapy (see page 22) is sometimes used to destroy the part of the tumor that is blocking the esophagus, temporarily relieving symptoms such as difficulty swallowing.
Disorders of the Stomach and Duodenum
After you chew and swallow food, powerful contractions of your stomach wall repeatedly crush and pulverize it. Stomach acid and enzymes break the food down into a pulp. The processed food trickles out of the stomach (through a ring of muscles called the pyloric sphincter) into the duodenum (the upper section of the small intestine at the entrance to the stomach). The duodenum secretes bile and more enzymes, which digest the pulp further before it passes into the rest of the small intestine. It takes from 3 to 5 hours for the contents of a meal to completely empty out of the stomach and duodenum and reach the lower part of the small intestine.
The stomach and duodenum
Food enters the stomach at the esophagogastric junction, where it is stored and partially digested. Muscles of the stomach wall crush the food and move it through the pyloric sphincter and eventually into the duodenum. The food is digested further in the duodenum and then passes into the rest of the small intestine.
Peptic Ulcers
A peptic ulcer is a hole or break in the lining of the stomach or duodenum (the beginning of the small intestine). The digestive juices secreted by the stomach are very acidic. Normally, the lining of the stomach and intestine is protected from this acid by a layer of mucus and a substance called bicarbonate, which is secreted by glands in the stomach wall. When this protective barrier is broken down, the digestive juices can come into contact with cells of the lining, damaging them.
Peptic ulcers that form in the duodenum are called duodenal ulcers. Peptic ulcers that form in the stomach are called gastric ulcers. In rare cases, an ulcer can develop on the lower esophagus and in the lower part of the small intestine. A peptic ulcer can break through the stomach lining completely, causing severe bleeding that can be fatal if not treated immediately.
A number of factors can contribute to the development of peptic ulcers. Infection with the bacterium Helicobacter pylori can cause peptic ulcers in some people by attaching to the protective lining and weakening it. Long-term use of pain relievers such as aspirin, ibuprofen, and naproxen also contribute to the development of peptic ulcers because these drugs can irritate the stomach lining when taken in large doses for long periods. Smoking is also a risk factor. Rarely, peptic ulcers are caused by tumors in the stomach or pancreas. Emotional stress, drinking alcohol, and eating spicy foods do not contribute to the development of peptic ulcers.
Symptoms
The main symptom of a peptic ulcer is burning, gnawing pain in the upper abdomen, lower chest, and, in rare cases, the upper back (between the shoulders). The pain is often worse about 2 hours after a meal and at night and can usually be relieved by eating something or taking an antacid. Other possible symptoms include nausea, vomiting (the vomit may be tinged with blood), and black, tarry stool (from bleeding). A rare condition called pyloric stenosis can result if scarring from a peptic ulcer blocks the pylorus