Narrowing of the esophagus

definition

The word Narrowing of the esophagus is actually self-explanatory.
The esophagus constricts, which means that food can no longer be adequately transported to the stomach. Most of it is the one lower section of the esophagus affected.
Usually middle-aged people between 40 and 50 are affected by a narrowing of the esophagus. An esophageal narrowing can various causes underlie. Often a triggering underlying disease plays a role.

Causes of a narrowing of the esophagus

An esophageal narrowing is very commonly associated with an Reflux disease (heartburn) on.
In the case of reflux disease, there is an increased production of stomach acid. Normally, the stomach acid should not leave the stomach, but with reflux disease it does Gastric acid reflux into the esophagus.
The mucous membrane of the esophagus, unlike that of the stomach, is not designed for the aggressive acid, so that the Increasingly damaged mucous membrane becomes.
The mucous membrane reacts to stomach acid by causing an inflammatory reaction, which can lead to a narrowing of the esophagus.

Inflammation of the esophagus can also go through bacteria or other pathogens are triggered.

Another cause of an esophageal narrowing can be a tumor which narrows the diameter of the esophagus.
If there are symptoms of a narrowing of the esophagus, a tumor must always be excluded as the cause.

Also one enlarged thyroid can press on the esophagus and narrow it.
In the context of a burn of the esophagus or a previous operation the esophagus, it can cause a scar come, which also narrows the diameter of the esophagus.

In rare cases, a congenital malformation the esophagus lead to a narrowing of the esophagus.

If there is a certain form of narrowing of the esophagus, it is also called one Achalasia.
The esophagus has two sphincter muscles. The lower sphincter can block the esophagus from the stomach and, among other things, ensures that stomach acid does not flow back into the esophagus.
In achalasia, the cause of the narrowing is that the lower sphincter permanently tense is. This means that there is no relaxation phase for the muscle and it is more difficult to empty the food into the stomach.
The lack of relaxation of the muscle is due to the destruction of nerve tissue.Why this happens has not yet been clarified.
In achalasia, there is one reactive extension the section located above the esophageal sphincter, as the food accumulates there and there is increased pressure.

Narrowing of the esophagus from alcohol

Chronic consumption of alcohol leads to a Inflammatory response in the stomach, as well as in the esophagus. If inflammation occurs, the cells must increasingly renew themselves, which means an increased risk of cell degeneration, i.e. an increased risk of cancer.

In addition, alcohol makes the mucous membrane more sensitive to toxic substances, which can also promote the development of cancer. The harmful effects of alcohol mainly depends on Amount of alcohol from and not of the kind of alcohol.
The resulting inflammation increasingly leads to one Narrowing of the esophagus. If cancer actually develops as a result of high alcohol consumption, the narrowing of the esophagus is self-explanatory.

Furthermore, alcohol causes the esophagus less agile and leads to relaxation of the sphincter muscle, so that it is easier for stomach acid to flow back into the esophagus, which also triggers an inflammatory reaction
This reflux in the sense of a Reflux disease is additionally promoted by the increased effect of alcohol on gastric acid production. Because of these effects of alcohol are above average often alcoholics affected by a narrowing of the esophagus.

Symptoms of a narrowing of the esophagus

The symptoms of a narrowing of the esophagus are mainly determined by the restricted transport of food to the stomach.
Those affected typically find it harder to swallow food (Dysphagia), because by swallowing harder, the body tries to overcome the increased pressure created by the narrowing in the esophagus.
Furthermore can Pain when swallowing occur.
The difficulties swallowing are hardly noticed in the initial phase of the disease and only appear to a rudimentary degree when swallowing solid food.
Affected then often drink more waterto wash the food down better.
In addition to the difficulty swallowing it comes to heartburn, a burning to painful feeling behind the breastbone, as well as a increased belching and Bad breath.

Belching occurs mainly in one lying position, this leads to belching of undigested food.
When lying down, gravity does not do its part to transport the food towards the stomach, so that belching can occur more easily.
By building up the food in front of the narrowing of the esophagus, the food gets there increased by bacteria, for this reason, the bad breath associated with the narrowing occurs. Weight loss can also be associated with narrowing of the esophagus.

If the disease is advanced, it can already swallowed food even again back in the mouth get, this is known as Regurgitation.

Treatment of a narrowing of the esophagus

Treatment of the narrowing of the esophagus is definitely needed if the symptoms are as very restrictive from the patient be felt.
Since a narrowing of the esophagus is mostly on the floor of a Underlying diseaseHow a reflux disease develops, it is often necessary to treat it in order to lead to a secondary regression of the esophageal narrowing.

The frequent triggering reflux disease is usually treated with so-called Proton pump inhibitors how Pantoprazole treated.
These serve to reduce the production of stomach acid. Is there a bacterial inflammation If the esophagus is the triggering factor, it is treated with antibiotics.
Will the Efficiently fights pathogens, should also narrow the esophagus form back on their own.
Is the esophageal narrowing a Achalasia underlying, i.e. a cramping of the lower sphincter, becomes a conservative one first, i.e. non-operative therapy route struck.
For this purpose, drugs are administered that are supposed to relax the sphincter muscle.

It is used for this, for example Nifedipine, which is usually used in the treatment of high blood pressure.
Nifedipine is a Antagonist of calciumwhich mediates muscle contraction.
The drug must be taken half an hour before food intake in order to lead to relaxation of the esophageal muscles in time. Often one hits conservative therapy in the context of achalasia, however, not on or the effect wears off after a certain time.

Surgery to narrow the esophagus

For example, surgery to narrow the esophagus is on one causing tumorwhich will be removed as part of the operation.
Another indication for surgery is when the esophagus is narrowing cannot be remedied by treating the underlying disease, such as the Achalasia.
In this case a Esophageal widening performed.

This is typically done with the help of a small balloon that is practically inflated inside the esophagus to expand it.
This procedure does not require major thoracic opening surgery; the operation can be performed using a Camera system with the mouth as access be made.

The whole thing can be done within a Gastroscopy take place, so it is not an operation in its own right.
Often times, this procedure will have to be repeated to restore the widening of the esophagus.

In addition to the mechanical expansion of the esophagus through the balloon procedure, a gastroscopy can also be used in the case of achalasia Botox can be injected into the muscle, which causes the muscle to relax over a period of time.

While the procedures mentioned are often only one temporary effect you can also have one through a special operation permanent expansion effect of the esophagus.
For this operation, the lower sphincter is split using ultrasound.

Then, if necessary, the position of the esophagus and the stomach entrance must be changed and these must be connected to one another.
This procedure is a major surgerywhich cannot be performed as part of a gastroscopy, but rather endoscopicby introducing a camera system and various surgical tools through several small skin incisions.

Provides Esophageal cancer the indication for an operation is often the entire esophagus removed.
To compensate for the missing esophagus, the Stomach surgically pulled upso that the food reaches the stomach directly through the throat.
This operation is a very large operation, which is subsequently associated with limitations for the patient.

Narrowing of the esophagus in babies / newborns

In babies, congenital esophageal malformations can lead to a narrowing of the esophagus, but this is relatively rare.
A constriction can occur, for example, after an esophageal operation of a congenital esophageal atresia (esophagus = esophagus).
Esophageal atresia is the absence of the lower opening of the esophagus into the stomach.
In another variant of the disease, the esophagus does not open into the stomach, but into the windpipe. This malformation must be corrected surgically shortly after the birth.
Subsequently, the surgically induced scarring can lead to a narrowing of the diameter of the esophagus.
Since malformations of the esophagus rarely occur, narrowing of the esophagus in newborns is a very rare case.

Reflux disease sometimes occurs in infants, which can then lead to a narrowing of the esophagus as a result of the inflammation that occurs.
Reflux disease in babies mostly occurs as part of a neurological disease or a reduced oxygen supply during birth.
The result of both cases is that the muscles in the esophagus cannot work properly, so that the reflux of gastric acid is easier and consequently reflux occurs.

Please also read our topic: Reflux in the baby.

Babies with a narrowing of the esophagus are particularly noticeable by refusal to eat, spitting, restlessness, coughing and frequent crying.

Read more on the topic: Nasogastric tube