Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
oral medications that help to relax the lower esophageal sphincter
such as nitrates (for example, isosorbide dinitrate
[Isordil]) and calcium channel blockers (for example, nifedipine
[Procardia] and verapamil [Calan]);
dilation (stretching of the lower
esophageal sphincter);
esophagomyotomy (surgery to
cut the sphincter); and
the injection of botulinum toxin
(Botox) into the
sphincter.
All four of these treatments reduce the pressure within the lower esophageal
sphincter to allow easier passage of food from the esophagus into the stomach.
What is achalasia?
Achalasia is a rare disease of the muscle of the
esophagus (swallowing tube). The term achalasia means "failure to relax" and
refers to the inability of the lower esophageal sphincter (a ring of muscle
situated
between the lower esophagus and the stomach) to open and let food pass into the stomach. As a result, patients with
achalasia have difficulty in swallowing food.
How does the normal esophagus function?
The esophagus has three functional parts. The uppermost
part is the upper esophageal sphincter, a specialized ring of muscle that forms
the upper end of the tubular esophagus and separates the esophagus from the
throat. The upper sphincter remains closed most of the time to prevent food in
the main part of the esophagus from backing up into the throat. The main part of
the esophagus is referred to as the body of the esophagus, a long, muscular tube
approximately 20
cm (8 in) in length. The third functional part of the esophagus is the lower
esophageal sphincter, a ring of specialized esophageal muscle at the junction of
the esophagus with the stomach. Like the upper sphincter, the lower sphincter
remains closed most of the time to prevent food and acid from backing up into
the body of the esophagus from the stomach.
The upper sphincter relaxes with swallowing to allow
food and saliva to pass from the throat into the esophageal body. The
muscle in the upper esophagus just below the upper sphincter then contracts,
squeezing food and saliva further down into the esophageal body. The ring-like
contraction of the
muscle progresses down the body of the esophagus, propelling the food and saliva
towards the stomach. (The progression of the muscular contraction through the
esophageal body is referred to as a peristaltic wave.). By the time the
peristaltic wave reaches the lower sphincter, the sphincter has opened, and the
food passes into the stomach.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Vitiligo is a condition in which the skin turns white due to the loss of pigment from the melanocytes, cells that produce the pigment melanin that gives the skin color.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Fundoplication is the standard surgical method for
treating gastro-esophageal reflux disease (GERD). GERD
causes inflammation, pain (heartburn), and other serious complications (such as scarring
and stricture) of the esophagus. GERD results when acid refluxes
(regurgitates, or backwashes) from the stomach back up into the esophagus. Under
normal conditions, there is a barrier to reflux of acid. One part of this barrier
is the lower-most muscle of the esophagus (called the lower esophageal sphincter). Most
of the time, this muscle is contracted (constricted, or tight), which closes off
the esophagus from the stomach. In patients with GERD, the sphincter does not
function normally. The muscle is either weak or relaxes inappropriately.
Fundoplication is a surgical technique that strengthens the barrier to acid
reflux when the sphincter does not function normally.
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