Esophageal Cancer

Common risk factors for esophageal cancer include smoking, alcohol intake, obesity, and long-standing acid reflux (GERD).

• Smoking and alcohol increase the risk of squamous cell carcinoma
• Obesity and GERD increase the risk of adenocarcinoma

The most common symptom is difficulty swallowing (dysphagia), which initially occurs with solid foods and later progresses to liquids.

• Chest pain
• Food regurgitation
• Weight loss
• Loss of appetite
• Breathing difficulty in advanced disease

Diagnosis

• Upper GI Endoscopy with biopsy
• CT Scan of chest and abdomen
• PET Scan in selected patients

Treatment

• Surgical removal when tumor is operable
• Pre-operative chemo-radiotherapy in advanced cases
• Endoscopic stent placement for swallowing difficulty
• Feeding jejunostomy if stenting is not possible

GERD (Acid Reflux Disease)

Gastroesophageal Reflux Disease (GERD) occurs when stomach contents flow back into the esophagus due to weakness of the lower esophageal sphincter.

Normally this valve allows food to pass into the stomach and then closes. When it becomes weak, acid reflux occurs.

Symptoms

• Heartburn
• Regurgitation
• Difficulty swallowing
• Chronic cough
• Worsening asthma

Risk Factors

• Obesity
• Hiatus Hernia
• Smoking
• Alcohol or coffee
• Large meals
• Pregnancy

GERD Complications

• Esophageal ulcers
• Barrett’s esophagus (precancerous condition)
• Benign esophageal stricture

Diagnosis

• 24-hour pH monitoring (gold standard)
• Upper GI Endoscopy
• Esophageal Manometry

Treatment

• Lifestyle modification
• Proton pump inhibitors
• Antacids
• Prokinetic medicines
• H2 blockers

Surgery is recommended when medications fail or hiatus hernia is present. The standard procedure is Nissen Fundoplication.

Hiatus Hernia

Hiatus hernia occurs when part of the stomach moves into the chest cavity through the opening in the diaphragm where the esophagus passes.

Types

• Sliding Hernia: Gastroesophageal junction moves into the chest
• Paraesophageal Hernia: Stomach moves beside the esophagus

Symptoms

• Heartburn
• Chest discomfort
• Food regurgitation
• Difficulty swallowing

Treatment

• Lifestyle modification
• Proton pump inhibitors
• Laparoscopic hernia repair
• Fundoplication surgery

Achalasia Cardia

Achalasia is a condition in which the lower esophageal sphincter fails to relax properly during swallowing.

• Difficulty swallowing
• Food regurgitation
• Chest discomfort

Diagnosis is made using endoscopy and esophageal manometry.

The standard treatment is Laparoscopic Heller’s Myotomy.

Corrosive Esophageal Injury

Corrosive injury occurs due to ingestion of acids or alkalis. It is usually accidental in children and intentional in adults.

Alkali ingestion mainly damages the esophagus while acids commonly affect the stomach.

Emergency Management

• Maintain airway and breathing
• Intravenous fluids
• Nil by mouth
• Vital monitoring
• X-ray chest and abdomen

Advanced Treatment and Surgery

Patients who develop swallowing difficulty after corrosive injury may require feeding jejunostomy for nutritional support.

CT scan is performed if complications such as perforation or necrosis are suspected.

In critically ill patients, emergency surgery may be required to control infection and prevent life-threatening complications.