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This is a tube which carries food from the mouth through the chest cavity to the stomach. It is designed to transport food down (swallow) and only let gas back up, from the stomach into the mouth to be expelled as a belch (or burp).
Swallowing Problems
Heart Burn
Hiatus Hernia
Cancer
Barrett’s Oesophagus
Difficulty in swallowing usually involves the feeling of food sticking, and this can be associated with pain in the throat or chest, at the same time. In general swallowing problems are divided into problems getting the food out of the mouth and into the gullet (oesophagus or swallowing tube) or problems that occur when the food has left the mouth and enters the gullet on its way to the stomach.
Problems transferring food from the mouth to the oesophagus are often the result of damage to the nerve supply after a stroke or due to conditions that affect muscle function such as motor neurone disease, where the muscles become very weak. Sometimes these conditions can lead to inhaling foods into the lungs by mistake (ie food goes down the wrong way) and this can cause choking and may cause infection in the lungs that can make the person very ill.
Problems with swallowing food after it has left the mouth are usually caused by obstruction of the gullet or gullet muscle disorders. Obstruction is usually caused by scarring of the gullet lining (mucosa) which results in a narrowing of the passage way that food normally travels in. This scarring most commonly results from acid reflux from the stomach into the gullet which burns the lining of the oesophagus. Acid reflux is often felt by the person it affects as heart burn. A growth (or cancer) can also (much less commonly) cause an obstruction. There are also nerve and muscle disorders that can affect the gullet and result in food sticking.
Problems transferring food from the mouth to the oesophagus are often the result of damage to the nerve supply after a stroke or due to conditions that affect muscle function such as motor neurone disease, where the muscles become very weak. Sometimes these conditions can lead to inhaling foods into the lungs by mistake (ie food goes down the wrong way) and this can cause choking and may cause infection in the lungs that can make the person very ill.
Problems with swallowing food after it has left the mouth are usually caused by obstruction of the gullet or gullet muscle disorders. Obstruction is usually caused by scarring of the gullet lining (mucosa) which results in a narrowing of the passage way that food normally travels in. This scarring most commonly results from acid reflux from the stomach into the gullet which burns the lining of the oesophagus. Acid reflux is often felt by the person it affects as heart burn. A growth (or cancer) can also (much less commonly) cause an obstruction. There are also nerve and muscle disorders that can affect the gullet and result in food sticking.
This is a common symptom caused by acid getting up into the gullet from the stomach. There is a valve in at the top of the stomach which stops foods and acid getting up into the gullet. If this valve does not work correctly it may allow the contents of the stomach to reflux up into the gullet. As the stomach usually contains a lot of acid and bile this will cause damage to the more delicate lining of the oesophagus and often causes pain which is felt as a burning sensation. Occasionally this refluxed acid results in ulcers, when these heal scar tissue is formed and this can occasionally cause narrowing of the gullet passageway (strictures). The more frequently people feel heartburn the more likely complications will occur. However, it is also quite common for people to have bad reflux and get significant damage to the gullet even when they do not experience symptoms of heartburn.
Reflux from the stomach into the gullet can aggravate asthma and cause chronic dry cough and dental problems.
Reflux from the stomach into the gullet can aggravate asthma and cause chronic dry cough and dental problems.
As the gullet passes from the chest cavity down into the abdominal cavity to join the stomach it has to pass through the diaphragm. The diaphragm is a sheet of muscle and fibrous tissue (or grissle) that separates the lungs from the abdominal organs such as liver, stomach and bowels. In order for the oesophagus to get though the diaphragm to reach the stomach there must be a hole and this is called the hiatus. Sometimes this hole becomes stretched and enlarges to allow part of the stomach to slip up from the abdominal cavity into the chest, this is called a hiatus hernia.
Cancer is caused by part of the body growing in an uncontrolled manner and excessively fast. It can also spread to and grow in places where it is not normally found and this is called metastatic cancer, where the cancer has spread to another part of the body. When a cancer has spread around the body to different sites it is more difficult to treat. There are several ways to treat cancer, these include the use of drugs to poison the rapidly growing cancer cells – chemotherapy, and the use of radiation which also kills rapidly growing cells – Radiotherapy. It is also sometimes possible to remove the cancer with a operation- surgical treatment.
When acid refluxes from the stomach in to the oesophagus and the lining of the oesophagus becomes irritated. Sometimes the body responds to this by growing stomach lining in the gullet, this is tougher and can better withstand the acid. Although this can often help reduce the symptoms from acid reflex this new lining is now in the wrong place and this makes it more likely become cancerous. When we find that somebody has Barrett’s oesophagus we therefore inspect it using an endoscopy (fibre optic tube with camera) at intervals of 1-3 years depending on the amount of Barrett’s present and if changes of early cancer are seen we can treat this before it becomes more severe.
This is when pain is felt in an area above the belly button (umbilicus) and below the rib cage in the front of the body or just to the sides. Pain can be caused by many things that occur in the organs and structures in this region. The stomach is perhaps the best known structure in this region and ulcers are also well known but they are not the commonest cause of pain here. In fact the most likely cause of pain is the irritable bowel syndrome, or sometimes trapped wind in the stomach which usually gets there from swallowing air. As there is a large amount of bowel present in the region as well as stomach the irritable bowel syndrome will also cause pain here. If the pain has a burning nature it might be caused by reflux of acid into the gullet from the stomach (Gastro-oesophageal reflux -GORD). If the pain is also felt in the back it could be caused by duodenal ulcers or pancreatic disease. Sometimes GORD pain also goes to the back as can gall bladder disease.
This is a term usually used to describe upper tummy pain after eating and is most often caused by reflux of stomach juices and food into the gullet (often felt as a burning pain in the central chest – heart burn). Other causes include air swallowing which results in bloating of stomach, and rarely ulcers or soreness of the stomach lining - gastritis.
H.pylori (Helicobacter pylori) was discovered to be the cause of stomach irritation and ulcers in both the duodenum and stomach in the late 1980’s and antibiotics soon became one of the main treatments for this type of ulceration. Not all ulcers in this region are caused by H.pylori infection however, and other common causes include the Non-steroidal anti-inflammatory drugs like ibuprofen and indomethacin.
Gastric cancer, as in the case of all cancers, is caused by the abnormal growth off tissue which spreads from the site where it started and invades nearby structures and can spread to other parts of the body and grow there as a secondary tumour – what is called a metastasis. Some cancers are easily spotted and therefore tend to be diagnosed at an early stage, but gastric cancer is often quite advanced before it causes enough symptoms for the person to seek medical help. Despite significant improvements in the treatment of gastric cancer over the last 20 years, it continues to be a difficult cancer to treat especially if it has spread to other parts.
Distension of the stomach can cause a sensation of bloating which is usually noticed during or soon after a meal. Sometimes this occurs if the person has overeaten but other times they have swallowed a lot of air whilst eating and this then either passes up as a belch (eructation) or downwardly as and may cause intestinal bloating and wind (flatulence). Some patients have an oversensitive stomach and feel bloated even when their stomach is not particularly distended, this is a type of irritable bowel (or irritable stomach).
Vomiting is often a sign of an underlying problem with the stomach and in most cases if persistent should be investigated further. Gastric ulcers can cause vomiting as can obstructions to the outflow of food from the stomach. Gall bladder disease can result in vomiting as can appendicitis. Some patients have problems with the way the muscles in the stomach work and when this causes a delay in stomach emptying it can result in vomiting.
In rare cases patients who vomit will bring up blood in the vomitus, sometimes the vomit is made up entirely of blood and this can be understandably very troubling and frightening for the person. In almost all cases urgent medical help is required and the patient should be admitted to hospital for investigations. In most cases an urgent endoscopy will be performed by a gastroenterologist so that the cause of the bleeding can be identified and treatment given to stop the bleeding.