The esophagus carries food from the mouth to the stomach. Some of the problems that can occur in this organ are tumors (both benign and malignant), diverticula (muscle defects with outpouchings), reflux (heartburn), and dysmotility. Some of these problems can be treated with medicines, while others require surgery. Diagnosis usually involves viewing the esophagus from the inside (esophagoscopy) which is done by a gastroenterologist. Other tests frequently needed include manometry (pressure studies) and x-ray studies using contrast material which is swallowed by mouth.

Esophageal tumors usually become evident due to difficulty swallowing (dysphagia). Benign esophageal tumors are rare and can often be left alone, but may require removal via thoracotomy or thoracoscopy. Esophageal cancers have been linked to alcohol and cigarette use. Other causes include chronic reflux of acid or bile from the stomach (heartburn) and caustic burns (such as lye ingestion). Unfortunately, like lung cancer, many esophageal cancers are incurable at the time of diagnosis. If symptoms are severe in such patients, relief can be provided by dilating the esophagus or placing a wire stent (steel-reinforced tube). Occasionally, esophageal tumors may require removal of nearly the entire esophagus (esophagectomy), and replacement with stomach or bowel. This involves major surgery, and requires an approach from the abdominal cavity and either the chest or the neck. Again, close interaction with the oncology team is required, since many of these tumors are also treated with chemotherapy and radiation therapy.

Esphogeal diverticula usually become apparent due to difficulty swallowing (dysphagia) or regurgitation of undigested food. They can occur in the neck, or anywhere along the esophagus. Symptomatic diverticula are removed and the tight muscles surrounding them are cut.

Gastroesophageal reflux usually causes symptoms of heartburn, but occasionally causes repeated episodes of aspiration of stomach contents into the lungs, which can lead to asthma or pneumonia. This is a disease that is often successfully treated with medicine. However, when medicines fail, anti-reflux surgery is required. This is commonly done through the abdomen using laparoscopic instruments, but can also be performed through the chest.

Esophageal dymotility often causes difficulty swallowing (dysphagia), but may also cause food to be regurgitated, or may present as substernal chest pain, and may even mimic a heart attack. Medical therapy is often successful in alleviating or lessening symptoms, but sometimes surgery is required. As in reflux surgery, the surgical approach is often via laparoscopy, but may require access from the chest.

Related Topics on the chest:

Lung Cancer
Non-Cancerous Lung Lesions
Esophageal Abnormalities