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Esophageal Obstruction

Alternate Names

  • blockage of the esophagus
  • Digestive system

Definition

Esophageal obstruction is a blockage or narrowing of the esophagus, the muscular tube that carries food from the mouth to the stomach. This condition usually causes problems with swallowing.

What is going on in the body?

Esophageal obstruction occurs when an abnormality, injury, or disease narrows the esophagus. Once the tube narrows, swallowing becomes difficult. If the esophagus gets completely blocked, swallowing cannot occur. At that point, vomiting occurs and sometimes stomach contents backflow into the lungs. This can cause a serious illness called aspiration pneumonia.

Risks

What are the causes and risks of the condition?

Esophageal obstruction can occur for a variety of reasons, including:
  • abnormal structures. A person may be born with an abnormal esophagus, such as esophageal atresia. It may have extra tissue, called esophageal webs, crossing through it. There may also be a ring of thick muscle around the esophagus, called Schatzki's ring.
  • injury. Children who swallow lye products, such as drain cleaners, can develop esophageal stricture, or narrowing. A person may also be injured by medications (such as aspirin, ibuprofen (i.e., Motrin, Advil) or tetracycline), or during an endoscopy, the examination of the esophagus and stomach with a lighted tube.
  • prolonged use of a nasogastric, or stomach, tube which can causeesophageal stricture
  • infection by certain viruses and bacteria, which can cause narrowing of the esophagus
  • other diseases, such as gastroesophageal reflux disease. In this condition, stomach acids come up into the esophagus and cause damage.
  • esophageal cancer, which can cause narrowing or blockage

Prevention

What can be done to prevent the condition?

Chemical injury can be prevented by storing dangerous chemicals in a safe place. Other injury can be prevented by careful medical procedures. Nasogastric tubes should be used only as long as necessary. Acid damage to the esophagus can be prevented by treating gastroesophageal reflux disease.

Diagnosed

How is the condition diagnosed?

A history of swallowing problems gives a clue to the diagnosis. Narrowing or blockage is diagnosed by x-rays taken after the person has swallowed a thick dye. This is called an upper GI series, or barium swallow. The reason for the narrowing can be found by endoscopy.

Long Term Effects

What are the long-term effects of the condition?

Depending on the cause, narrowing can progress to total blockage. Narrowing that is not relieved can lead to poor malnutrition and weight loss. Total blockage can cause regurgitation of food and liquid into the lung. In this case, these materials can cause an inflammatory condition with difficulty breathing, known as aspiration pneumonia. Esophageal cancer can spread and lead to death.

Other Risks

What are the risks to others?

There is no risk to others.

Treatments

What are the treatments for the condition?

Narrowing caused by abnormal structures or injury may be relieved by dilation. In this procedure, instruments of increasing size are inserted through the narrowed area. This gradually opens the esophagus. The procedure may have to be repeated to relieve the symptoms. Dilation may also have to be repeated if the narrowing returns.
Sometimes a stent, or expandable tube, is placed through the narrow area to keep it open.When dilation does not fix the problem, surgery may be necessary.

Sometimes just the narrowed portion can be removed. Other times, the esophagus is replaced with a piece of the stomach or large intestines.

Radiation therapy or chemotherapy can be successful in treating esophageal cancer.

Side Effects

What are the side effects of the treatments?

Dilation of the esophagus may not work, can occasionally tear the esophagus, or may have to be repeated. Any surgery can be complicated by bleeding, pain, or infection.

After Treatment

What happens after treatment for the condition?

Sometimes the narrowing returns. In that case, dilation may have to be repeated. If dilation does not work, surgery may be needed.

Monitor

How is the condition monitored?

If symptoms worsen and cannot be controlled by dilation, surgery may be needed.

Sources

Scientific American Medicine 4(I):1-12.

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