Achalasia occurs when there is failure of the valve at junction of esophagus and stomach to relax on swallowing. As a result, there is loss of ability to squeeze food down into the stomach. Dysphagia to solids and liquids is the most common symptom of the disease, followed by regurgitation of undigested food, chest pain, weight loss, nocturnal cough, and heartburn. Patients with suspected achalasia should undergo a barium esophagogram, an upper gastrointestinal endoscopy, and esophageal manometry to confirm the diagnosis. Among nonoperative treatment techniques, endoscopic dilation and botulinum toxin injection are done frequently. However, laparoscopic myotomy with partial fundoplication(Heller- Dor procedure) provides superior and longer-lasting symptom relief with low morbidity for patients with achalasia compared with other treatment modalities. Peroral endoscopic myotomy (POEM) procedure is also done endoscopically for treatment of achalasia. This procedure, though has the advantage of being an endoscopic procedure not requiring any incision on the abdomen, is associated with significant reflux symptoms necessitating lifelong medications.
At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices, which have a high acid content, into the esophagus. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and causes injury to the inner lining of the esophagus, causing heartburn and eventually may damage the esophagus. Other symptoms may also include vomiting or regurgitation, difficulty swallowing and chronic coughing or wheezing. A few patients may develop a condition in which there is a change in the type of cells in the lining of the lower esophagus, called Barrett’s esophagus. This is important because having this condition increases the risk of developing cancer of the esophagus. GERD is generally treated in three progressive steps: lifestyle changes, drug therapy and surgery.Surgery is very effective in treating GERD. Laparoscopic antireflux surgery (also called Nissen fundoplication) is used in the treatment of GERD when medicines are not successful. It is a minimallyinvasive (laparoscopic)procedure that corrects gastroesophageal reflux by creating an effective valve mechanism at the lower end of the esophagus.
3. Potentially catastrophic presentation and lifelong complications resulting from caustic ingestion make it a challenging clinical situation in gastroenterology. Alkaline caustics and acids are the commonest chemicals implicated in caustic burns. Burns from ingestion of such agents may include the oral, pharynx, larynx, esophagus and stomach. Destruction of tissues or of these organs may lead to complications, of which respiratory compromise, esophageal and gastric perforation, septicemia, or even death might occur. Stricture formation with inability to swallow food after the injury is inevitable in some cases. Repeated endoscopic dilations to maintain an adequate lumen diameter are done in patients with chronic strictures. As for the complications and ineffectiveness of the dilation in more severe strictures, surgical replacement of esophagus may be required. The diseased esophagus is usually bypassed or resected with replacement by stomach, colon or rarely jejunum. These patients need very careful evaluation and treatment planning which in expert hands result in restoration of normal swallowing function and diet.
Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. Smoking, heavy alcohol use, and Barrett esophagus can increase the risk of esophageal cancer. Signs and symptoms of esophageal cancer include: difficulty in swallowing (dysphagia), weight loss, heartburn, coughing or hoarseness. What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer's stage, your overall health and your preferences for treatment. Surgery is the most common treatment for cancer of the esophagus. Part of the esophagus may be removed in an operation called an esophagectomy or upper portion of stomach may also need to be removed (esophagogastrectomy).Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy is often combined with radiation therapy. Targeted drug therapy or immunotherapy are also used to fight esophageal cancer.