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Anal Fissure
Barrett's Esophagus
Colon Polyps and Cancer
Constipation
Crohn's Disease
Diarrhea
Diverticulosis & Diverticulitis
Esophagitis and Stricture
Gallstones
Gas
Gastritis
Gastroparesis
GERD
Heartburn and Reflux
H Pylori
Hemorrhoids
Hiatus Hernia
IBS
Lactose Intolerance
Ostomy
Pancreas Disease
Peptic Ulcer Disease
Prevention of Colon Polyps and Cancer
Rectal Bleeding
Ulcerative Colitis
Autoimmune Hepatitis
Cirrhosis
Fatty Liver
Hemochromatosis
Hepatitis
Hepatitis B
Hepatitis C
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis (PSC)
| | Esophagitis and Stricture
The esophagus is the food tube, or gullet, that carries food and liquid from
the mouth to the stomach. The stomach churns the food and secretes a strong acid
that aids in digestion. A specialized muscle, known as the lower esophageal
sphincter (LES), is located at the end of the esophagus. This muscle normally
contracts firmly, relaxing only to allow food and liquid to pass from the
esophagus into the stomach. This muscle maintains a certain pressure to keep the
end of the esophagus closed, preventing stomach acid and digested food from
moving back into the esophagus.
 However,
the LES muscle does not always work perfectly. It can easily be overcome by a
number of factors, the most common being eating a large meal. Other agents that
weaken the LES muscle and allow reflux of stomach juices are:
 | Nicotine (cigarettes)
| Fried or fatty foods
| Chocolate
| Coffee
| Citrus fruits and juices
| Peppermints
| Pregnancy |
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What Is Esophagitis?
When stomach acid and digestive enzymes repeatedly reflux into the esophagus,
the tissues become inflamed and ulcerated. This inflammation is known as
esophagitis. When the inflammation is severe, esophageal ulcers develop.
Does a Hiatus Hernia Cause Esophagitis?
A hiatus hernia exists when part of the stomach protrudes through the diaphragm
muscle into the chest. When the hernia is fixed in this position, stomach acid
and food do not drain out of it quickly and the LES pressure is overcome. This
results in tissue damage to the esophagus. A fixed hiatus hernia, therefore, is
an important factor in causing esophagitis.
Are There Other Causes of Esophagitis?
Certain infections, such as a fungus infection (monilia, candida) and viruses,
can occur in the esophagus and cause inflammation. Irradiation and caustic
substances, like lye, also can cause esophagitis. Acid reflux from the stomach,
however, is by far the most common cause of the condition.
What Are the Signs and Symptoms?
Heartburn occurs when acid refluxes into the esophagus. It is experienced as a
burning sensation in the lower chest and may be felt up the esophagus. At times,
bitter-tasting liquid may regurgitate up into the mouth. When esophagitis is
severe and ulcers are present, swallowing may cause pain when food reaches this
part of the esophagus. Furthermore, if the lower esophagus narrows due to
scarring, food may stick in this area. This symptom is called dysphagia and is
uncomfortable. Esophagitis also may cause bleeding. Black stools, anemia (low
red-blood cell count), and vomiting of blood are signs of bleeding.
Diagosis
An upper GI series x-ray is usually done to outline the esophagus. An
endoscopy also is performed during which a flexible, fiberoptic endoscope is
passed into the esophagus while the patient is lightly sedated. The tissues can
be visualized and biopsied during this procedure. This examination is important
since cancer of the esophagus can mimic esophagitis. 
Treatment
| General measures the patient can take to treat esophagitis are:
| Eat smaller and more frequent meals.
| Avoid eating for 2 hours before going to bed.
| Eliminate excessive bending, lifting, abdominal exercises, girdles, and
tight belts, all of which increase abdominal pressure and provoke reflux.
| If overweight, lose weight. Being overweight causes reflux.
| Eliminate or significantly reduce consumption of nicotine (cigarettes),
fatty foods, alcohol, coffee, chocolate, and peppermint.
| Elevate the head of the bed 8" to 10" by placing pillows or a
wedge under the upper part of the mattress. In this way, gravity helps keep
stomach juices out of the esophagus during sleep. |
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Other Treatments Include:
Antacids -- These can and should be used often. Generally, antacids
should be taken 30 to 60 minutes after eating and at bedtime. Liquids are
preferred to tablets, with the strongest being Maalox II, Mylanta II, Gelusil
II, and Extra Strength Riopan.
Drugs -- Medicines are now available that effectively reduce or stop
the secretion of stomach acid. Other medications increase the strength of the
LES muscle. These medicines are usually the most important part of treating
esophagitis.
Surger -- Surgery is occasionally required to treat esophagitis,
especially if a hiatus hernia is present and when the above steps have been
ineffective. Newer laparoscopic surgery has simplified this procedure.
What Is a Stricture?
The lower esophagus can open to the size of a quarter or wider. When recurrent
inflammation occurs in the esophagus, scarring develops, underlying tissues
become fibrous, and the opening narrows. In advanced cases, this narrowing, or
stricture, can be severe. The opening may be reduced to the size of a pencil or
even smaller. Food and fluid are delayed and only move slowly across the opening
into the stomach. A large piece of food, such as meat, may completely block the
esophagus. As mentioned, cancer can narrow the esophagus in the same way.
Therefore, it is critical that the physician rule out this diagnosis. 
Treatment
The physician can use a variety of methods to gently but forcefully open, or
dilate, a stricture. Dilatation is often performed in conjunction with an upper
endoscopy exam. one of the following dilatation methods may be used:
Bougie -- A series of increasingly larger, soft rubber or plastic
dilators are moved across the stricture, gently opening it.
Guided wire -- A thin wire, placed across the stricture, is used to
guide increasingly wider dilators over it.
Balloons -- Different types of sausage-shaped balloons can be placed
across the stricture. The balloon is sharply inflated to open the narrowed
area.
The physician chooses the type of dilatation that is most appropriate for
each patient.
Are There Any Alternatives to Dilatation?
The only alternative to dilatation for opening a stricture is surgery. It is
recommended only in the most extreme cases and when dilatation fails.
Complications
With dilatation, minimal bleeding almost always occurs, although it is rarely
excessive or serious. A rare, but serious, complication is a perforation, or
tearing, of the esophagus. This causes increasing pain after the procedure and
may require surgery to correct.
Summary
Esophagitis usually can be treated easily with a conservative program of medical
care. When scarring becomes severe, a stricture can occur. This condition can be
treated by simple dilatation. While complications can occur, they are uncommon.
Most patients obtain complete relief of their swallowing problems. By working
with the physician, the correct program can be developed for each patient.
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