Why does food not pass through the esophagus? Esophageal motility disorders. Oak bark decoctions

Esophageal obstruction may be associated with severe organic lesions.

Among them are the entry of foreign objects into the esophagus, tumors, and inflammation. If signs of a disorder appear, it is recommended not to postpone a visit to the doctor, but to find out its causes as soon as possible and begin treatment.

Esophagus

A long, hollow organ that resembles a tube that leads from the pharynx to the stomach is called the esophagus.

Its inner surface is lined with several layers of epithelial tissue. She is not prone to keratinization. Its characteristic property is the ability to recover quickly.

Muscle tissue consists of two layers. The outer one is formed by longitudinal fibers, their function is to ensure expansion of the organ.

The internal one is formed by circular muscles, they narrow it. A muscular seal is formed below - the sphincter. It separates the esophagus from the stomach cavity.

The outer surface is formed by connective tissue. Functionally, it is aimed at connecting the esophageal tube with the organs that are located in the chest. The looseness of the fabric allows it to stretch and contract.

In some places the esophagus has a natural narrowing. Its functions include:

Transport. Due to the work of muscle tissue, food moves through the tube into the stomach.
Secretory. The mucous membrane secretes a secretion that lubricates food.
Protective. The sphincter prevents food from flowing back in.

Narrowing of the esophagus

Normally, food passes through the esophagus freely, without restrictions. Sometimes there are pathological constrictions, partially or completely preventing the passage of the food bolus.

The disorder occurs due to obstruction, problems with motor function, and compression of the esophagus from the outside.

The narrowing of the lumen is temporary or permanent. Next, we will consider what causes the appearance of pathology.

Causes

A large number of pathologies lead to narrowing of the esophagus. Benign and malignant causes associated with organic lesions.

Benign

This group includes various neoplasms: benign tumors, scars formed due to burns or previous injuries.

Reflux leads to disruption of the patency process - the reflux of stomach contents and the resulting ulcers and inflammation.

The pathology is caused by burns of the esophagus due to ingestion chemical substances, acids.

Blockage of the esophagus occurs as a result of ingestion foreign objects. Most often, as a result of this, pathology appears in young children.

Its rings protrude into the cavity of the esophagus. These are round narrow formations of a benign nature.

Are considered physiological norm. However, in some cases they occur as complications of certain diseases, for example, gastroesophageal reflux. Several rings lead to difficulty swallowing.

The formation of diverticula is another reason why esophageal obstruction occurs in older people.

What to do if this pathology is discovered, the doctor will tell you after clarifying the diagnosis.

Compression occurs due to certain diseases of the chest organs.

Pathology is caused by an enlargement of the left atrium - this part of the heart is directly adjacent to the esophageal tube. Protrusion of the aorta also leads to narrowing - aneurysm, cardiospasm.

The cause of compression is the growth of the thyroid gland, in particular the formation of a goiter. It can also be caused by a hernia in the diaphragm.

An additional cause not related to compression or blockage is inflammatory damage to the intercostal nerve.

Cause frequent violation in children - esophageal atresia. Organic pathology is associated with congenital absence of lumen.

Not so often in older people, the disease appears due to the entry of bezoars into the esophagus - formations formed from hair, drug residues, and food.

Malignant

Blockage of the esophagus develops due to the formation cancer cells. The disease is considered the second most common factor that causes obstruction.

Functional

The reasons highlighted above are associated with organic lesions. However, there are a number of factors that lead to esophageal obstruction, but they are associated only with functional manifestations.

This is achalasia - a disease of the neuromuscular system, characterized by the fact that when swallowing the sphincter between the esophagus and the stomach does not work.

Psycho-emotional disorders - hysteria, panic attacks - cause a reflex spasm of muscle tissue.

Muscle contraction occurs due to disruption of connections between nerve cells in pathologies of the nervous system.

Symptoms

The main symptom that characterizes esophageal blockage is difficulty swallowing.

The extent to which this symptom is expressed depends on the consistency of the food and the narrowing of the esophageal tube. There are several stages of manifestation of dysphagia:

At first, a person feels discomfort when, while eating, pain in the sternum area. Unpleasant sensations appear due to spasms of the esophagus. Sometimes they resemble an attack associated with heart disease. At this stage, disorders are easier to treat.
On the second, the person notes that he has difficulty swallowing large pieces. Drinking water relieves the condition.
As the third stage narrows, it becomes difficult to swallow ground foods.
On the fourth it hurts to drink.
The last stage is characterized by complete obstruction; even liquid does not enter the stomach. This is often how esophageal obstruction manifests itself in older people. They didn’t know what to do before, or they hoped that everything would go away. As a result, the disease was pushed to its last stage.

Symptoms increase gradually over several months. Along with pain when swallowing, there is a growing feeling that something is interfering with eating.

The disease develops. Please note that vomiting appears, and sometimes blood streaks are found in it.

There is a belching that smells like a rotten egg. Salivation increases, which increases when eating solid food. Heartburn occurs due to leftover food that has not penetrated into the stomach.

The feeling that there is something inside does not go away for some time after eating. Many patients report heartburn.

As the pathology develops, it is noted quick loss weight, lack of nutrients.

There is a deterioration in the condition of hair, skin, and nails. Weakness develops. The patient is unable to perform physical work, concentrate for a long time.

The incidence of infectious diseases is increasing.

Pathology has a negative impact on the psycho-emotional sphere. Patients become nervous, irritable, and prone to hysterics.

The disease caused by protrusion of the esophageal rings manifests itself differently. Attacks of swallowing disorders occur periodically, several months pass between them.

Vomiting leads to relief. After it, the patient can swallow again without pain or discomfort.

Diagnostics

Typically, a narrowing of the esophagus is indicated by the signs described by the patient. To detect the exact cause, a comprehensive instrumental study is prescribed.

It includes:

Radiography. The patient is given a barium sulfate suspension. The diagnostician monitors its movement on the fluoroscope monitor and takes pictures. In the place in front of the obstacle, there is an expansion of the esophagus, after it there is a narrowing. The tumor is detected as an uneven local obstruction. External compression is indicated by smooth edges. If there is a scar, filling is disrupted along the entire length of the tube. Obstruction caused by cardiospasm is not always detected.
Fibrogastroduodenoscopy. The inserted flexible probe allows you to thoroughly examine the mucous membrane of the esophagus, stomach, and intestines. This method is considered the most informative, because allows you to immediately detect inflammation, tumors, scars, the nature of the disorder, how narrowed the esophagus is. At the same time, a tissue sample is taken to clarify the quality of the process. Sometimes severe narrowing does not allow the use of FGDS.
Ultrasound. The main purpose of this method is to see the factors affecting the esophagus from the outside. Endoscopic examination allows you to explore internal structure. To do this, an ultrasound sensor is inserted into the lumen of the esophagus.
CT scan. Layer-by-layer images help to see the structure of the internal walls and surrounding organs. If necessary, CT is performed with a contrast agent. An MRI is performed as an alternative. No contrast input is required.
Chromoscopy. A probe is inserted through which paint is sprayed onto the mucous membrane. Contrast agent may be administered intravenously. In any case, areas where staining occurred unevenly are analyzed.
Esophagomanometry. Using a special catheter under local anesthesia The contraction pressure of the walls is measured. In this way, information about motor impairment is obtained.

When diagnosing esophageal obstruction, an additional general analysis blood. It allows you to detect signs of inflammatory processes and anemia. Biochemistry is prescribed.

After FGDS, the biomaterial is examined.

Gastroenterology addresses are in reference books.

First aid

The sudden primary occurrence of obstruction can be caused by spasm of the muscles of the walls of the esophagus.

In a situation where the pain does not go away, call an ambulance.

They act differently if a person has swallowed a foreign object. First of all, they call an ambulance. Avoid squeezing the abdomen to remove the object.

If signs gradually develop that indicate obstruction of the esophagus in older people, the doctor will tell you what to do.

They turn to him to determine the diagnosis and prescribe therapy.

Treatment

The causes of esophageal obstruction determine treatment tactics. It includes the use of medications and diet therapy.

If necessary, surgical intervention is performed. Complement treatment of the esophagus folk remedies.

Drug therapy

Medicines are used if the narrowing is associated with ejection of hydrochloric acid and leftover food from the stomach. They are indicated for pain relief and sedation.

To reduce the effect of hydrochloric acid, prevent the appearance of scars and heartburn, antacids are prescribed, in particular Almagel.

Antisecretory drugs are aimed at reducing the production of hydrochloric acid. These include Omeprazole.

The action of prokinetics is aimed at improving muscle peristalsis. Use the following drugs: Cerucal, Motilium.

If necessary, sedatives (tincture of Valerian, motherwort) and antispasmodics (No-shpa, Spazmalgon) are prescribed.

Self-treatment is contraindicated, even if repeated obstruction of the esophagus is detected in elderly people; they already know what to do, because encountered the symptoms for the first time before. The duration of medication is determined by the doctor.

Invasive intervention

If obstructions in the esophagus or compression are objectively detected, invasive intervention and surgery are performed.

Foreign objects are removed. In some cases, the operation is performed several times.

To increase the lumen of the esophageal tube, metal rods are inserted into its narrowed area.

The procedure is called endoscopic bougienage. Instead of a rod, a balloon is also inserted inside the lumen and inflated into the cavity of the esophagus.

If scars are detected, treatment of esophageal obstruction is carried out by cutting them with current.

The operation is performed through the lumen of the esophagus. After the procedure, balloon expansion is performed.

Severe wall damage is considered an indication for endoprosthetics. The area of the affected muscle is removed and a prosthesis is installed in its place.

Cysts, tumors, and protrusions of the esophageal wall are removed surgically.

Chemotherapy, radiation, surgical methods. Operations are performed at gastroenterology hospitals.

Diet

If food is obstructed in the esophagus, doctors advise using the following recommendations:

Table No. 1 includes boiled or steamed dishes.
Table No. 1a limits salt intake. Products rich in vitamins are used. Bread is excluded fatty foods, baked goods, sour fruits, sausages, canned food. Do not drink drinks containing caffeine.
Table No. 1b is based on a low-calorie menu. Dishes are served boiled and ground. The consistency is like porridge.

Dishes are served warm. Eat up to 6 times a day in small portions.

ethnoscience

Traditional medicine cannot be the main treatment. It is carried out only after consultation with a doctor.

They are aimed primarily at restoring work gastrointestinal tract, relieving heartburn, healing damage.

A decoction of dried, finely chopped mint, plantain leaves and chamomile flowers is boiled for thirty minutes, drained and cooled. Take every day for a week before each meal.

An infusion of marshmallow and St. John's wort leaves is brewed in boiling water and infused for half an hour. Drink before meals.

Every morning before breakfast, you can eat a teaspoon of honey or drink diluted aloe juice.

Before going to bed, it is recommended to take a mixture of honey, olive oil, hay and raisins.

Complications

Frequent complications include anorexia and water-salt imbalance. In severe cases of pathology, peritonitis may develop.

The prognosis depends on the factors that caused the obstruction. When a cancerous tumor forms, the prognosis is unfavorable.

Timely treatment of a disease caused by benign causes makes it possible to cope with it relatively effectively.

Prevention

Constant monitoring of your health helps to avoid intestinal obstruction, in particular, timely diagnosis the appearance of neoplasms.

You should not exercise immediately after eating. It is recommended not to eat before bed, not to overeat, and active image life.

Clothes should be loose and not constrict the abdominal area.

Those people who have been diagnosed with gastritis need to be especially attentive to their health. peptic ulcer working in chemical production conditions.

Blockage of the esophagus occurs due to the entry of foreign objects into it, the growth of tumors, decreased peristalsis, and diseases of neighboring organs.

If treatment is started at the wrong time, it can lead to serious consequences and even death. Treatment uses medications, invasive interventions, and surgical methods. Be sure to follow a diet.

Useful video

– pathological condition, characterized by disruption of the passage of food masses through the esophagus due to its stenosis, obstruction or external compression. The clinical picture is dominated by impaired swallowing, increased salivation, chest pain and heartburn, belching of air and eaten food, and weight loss. To identify this pathology, esophagoscopy, endoscopic biopsy, radiography of the esophagus, chromoscopy of the esophagus and stomach, and esophageal manometry are used. Treatment depends on the etiology of the process. To restore patency, endoprosthetics of the esophagus, endoscopic dissection of scars, bougienage of the esophagus, etc. are used.

ICD-10

K22.2

General information

Esophageal obstruction is serious complication many diseases, but most often it is caused by accidents (intentional or accidental intake of acids and alkalis by both children and adults) and malignant tumors of the esophagus. Among benign narrowings of the esophagus, burn strictures predominate (70%), while almost 90% of patients with scars after burns are people of working age. The number of patients in whom malignant and benign tumors of the esophagus first manifest symptoms of obstruction is also increasing. Despite the continuous improvement of surgical methods and the increasingly widespread use of minimally invasive methods for treating esophageal obstruction, this problem in gastroenterology is very relevant, since the incidence of critical stenosis of the esophagus remains consistently high.

Causes

Obstruction of the esophagus develops when its lumen is significantly narrowed. Due to the occurrence of stenosis, esophageal obstruction can be benign or malignant; caused by the formation of esophageal rings or complications of other diseases.

Benign esophageal obstruction is usually associated with the formation of scarring strictures within several months or years after a burn to this organ. The most severe changes in the esophagus occur when active alkali is ingested. The consequences of a burn of the esophagus with acid are less catastrophic; scar changes are not as pronounced and are easier to correct than when exposed to alkali. Enough common reasons Obstruction may include compression of the esophagus from the outside (mediastinal tumor, aberrant vessels, enlarged lymph nodes, etc.), benign tumors of the esophagus with intraluminal growth, peptic ulcer, prolonged inflammatory process (esophagitis).

Malignant stenoses develop against the background of esophageal cancer, which accounts for more than 80% of all diseases of this organ and 4% of all oncological pathologies. Esophageal cancer ranks sixth among all malignant tumors and is the second most important cause of esophageal obstruction.

Esophageal rings are benign, smooth, narrow concentric protrusions of tissue into the lumen of the esophagus. The rings can contain three layers: mucous, submucosal and muscular. A type A esophageal ring is considered a structural feature of the organ; most often it has no clinical manifestations and is an accidental finding during an examination for other diseases. The exact cause of type B esophageal rings (Schatzky rings) is still unknown, although most often their appearance is associated with esophageal dysmotility and gastroesophageal reflux. Type B rings can be detected in 6% of adults, most often in patients over 50 years of age. They do not appear in any way for a long time, however, when several rings form and there is a significant narrowing of the lumen of the esophagus at the site of their localization, severe dysphagia and pain occur when a bolus of food is retained between two rings and stretches the esophagus.

More rare causes of obstruction are esophageal diverticulum, trauma and foreign bodies; tuberculosis, syphilis, scleroderma with damage to the esophagus. The vast majority of cases of esophageal obstruction in newborns are caused by such a rare congenital pathology as esophageal atresia (a developmental defect in which there is underdevelopment of part of the esophagus, lack of communication between the pharynx and stomach).

One of the rarest causes of esophageal obstruction is a bezoar. Bezoars are formed in the esophagus or stomach of patients (mainly old age) from plant fibers, hair, medications taken, etc. The formation of bezoars occurs due to a violation of the secretion and peristalsis of the esophagus, as a result of which a dense lump is formed that blocks the lumen of the organ. With general dysfunction of the digestive tract, bezoars can migrate into the esophagus from the stomach and even from small intestine. To date, isolated cases of detection of esophageal bezoars have been described in the literature.

Symptoms of esophageal obstruction

The first and main symptom of esophageal obstruction is usually impaired swallowing - dysphagia. The severity of this symptom varies significantly depending on the level of esophageal stenosis and the consistency of food consumed. Liquid food and water can pass painlessly and easily into the stomach, causing minor discomfort in the chest. When eating solid and dense foods, dysphagia is significantly pronounced, accompanied by severe chest pain and vomiting. The symptoms of dysphagia develop gradually, gradually leading to the fact that the patient can only take liquid food and completely refuses other food, which is associated with significant weight loss due to obstruction of the esophagus. In addition to dysphagia and chest pain, the patient may be bothered by belching, hypersalivation, and a burning sensation behind the sternum.

For esophageal rings, slightly different symptoms are characteristic. Persistent dysphagia is uncommon; Episodes of swallowing disorders are rare; months, sometimes years, may pass between two episodes. Liquid food and water move freely through the esophagus and do not cause any discomfort. The dysphagia attack itself is usually very short. Most often, when food is retained between two rings, eliminate unpleasant symptoms vomiting helps, after which the patient can calmly continue to eat without any discomfort. Dysphagia in patients with esophageal rings occurs mainly due to the consumption of freshly baked bread and fried meat.

Mechanical obstruction of the esophagus is differentiated from functional disorders (achalasia - diffuse tonic spasm of the esophageal muscles), hysterical seizures, panic attacks, psychiatric pathology.

Diagnostics

Consultation with a gastroenterologist is required for the initial diagnosis of esophageal obstruction. After establishing final diagnosis the patient is sent to the surgery department. Detection of cicatricial changes, strictures and stenoses is carried out using radiography of the esophagus with contrast. A consultation with an endoscopist is needed to prescribe and perform esophagoscopy, identification and verification immediate causes obstruction of the esophagus (tumors, specific diseases, foreign bodies and etc.). Also, computed tomography of the esophagus with contrast and endosonography of the esophagus are of great importance for diagnosing a tumor of the esophagus.

If esophageal cancer is suspected, endoscopic biopsy, chromoscopy of the esophagus and stomach may be required. At systemic diseases If achalasia of the cardia is suspected, esophageal manometry is indicated. If the patient has specific diseases (syphilis, tuberculosis, scleroderma), the examination plan corresponds to the identified pathology.

Laboratory tests for esophageal obstruction reflect pathological changes caused by the underlying disease. A biochemical blood test may show anemia, decreased levels total protein and a violation of the ratio of protein fractions, (stenting) of the esophagus. To restore patency of the esophagus, it may be necessary to remove a foreign body, surgical removal of a tumor, or esophageal cyst. Conservative or surgical treatment of the disease, which has led to external compression of the esophagus, is also carried out.

Malignant forms of esophageal obstruction require pathogenetic treatment: radiation or chemotherapy, surgical removal of the tumor followed by esophagoplasty. Conservative measures include normalizing the level of essential nutrients in the blood and electrolytes. If necessary, nutrition is adjusted and medications are prescribed to treat anemia.

Prognosis and prevention

The prognosis of esophageal obstruction varies depending on the etiology of the disease, the possibility of alternative methods nutrition. Benign forms of esophageal obstruction have a better prognosis and are easier to treat than esophageal obstruction caused by the progression of a cancerous tumor. Specific prevention There is no esophageal obstruction. To prevent this state Etiological and pathogenetic factors of esophageal obstruction should be avoided.

ICD-10 code

Of the three parts of the human esophagus suffers from obstruction thoracic region. It is more often susceptible to tumor damage and trauma. Pathological process accompanied by dysphagia, that is, impaired swallowing function. This occurs due to an abnormal narrowing of the lumen of the esophagus, which prevents the normal passage of solid foods and liquids.

Injuries chest area may cause obstruction of the esophagus.

Description of the pathology

Obstruction is the appearance of a barrier that causes narrowing or blocking of the esophageal lumen. Poor permeability makes it difficult for food and liquid to enter the stomach. In most cases, the pathology develops after damage to the esophagus.

When a wound, crack or scratch heals, connective tissue forms on the walls of the digestive tract, forming a seal. This scarring causes narrowing of the lumen.

Less commonly, obstruction of the esophagus occurs against the background of the development of cancer in its wall. External compression of the tract by nearby pathological tissues is also possible.

Stages

a person feels discomfort when swallowing. Unpleasant, poorly expressed sensations arise behind the sternum;
It becomes difficult to swallow pieces, solid food does not pass well. Relief occurs when drinking water;
it is difficult to eat pureed, pureed and porridge-like food, it also does not pass well;
pain when swallowing occurs when drinking any liquids and drinking water;
the critical stage, when complete obstruction occurs, not allowing even water to be consumed.

Forms

Narrowing of the esophagus of benign origin. Appears against the background of chemical burns, intentional or accidental use of cauterizing liquids, untreated ulcers in the deep layers of the mucous membrane of the esophageal walls.
Stenosis of malignant origin. Appears with esophageal cancer.

These two forms have 4 degrees:

1st degree, when the size of the narrowing in diameter is 9-11 mm;
2nd, when the diameter is 6-8 mm;
3rd - 3-5 mm;
4th - 1-2 mm.

Causes

Causal factors for obstruction can be caused by organ diseases and injuries. The most common cases:

development of deep ulcers in the epithelium of the esophagus;
the presence of saccular protrusions in the walls of the organ - diverticula;
the appearance of cardiospasm, that is, narrowing of the alimentary tract in the area of its connection with the stomach;
the development of benign and malignant tumors with a cell type that is the same or different from those that form the organ;
the onset of gastroesophageal reflux, characterized by the release of gastric contents back into the esophagus;
development of ulcerative esophagitis, that is, inflammation of the mucous membrane with the appearance of deep defects;
consumption of aggressive liquid chemicals (acids, alkalis), hot food and drinks that cause burns with stenosis;
ingress of foreign particles;
open wounds and closed injuries;
mechanical damage;
consequences severe infections, such as tuberculosis, fungal mycosis;
presence of systemic diseases connective tissue, for example, with damage to blood vessels, various organs and tissues, which causes the proliferation of fibrous tissue with a decrease in the esophageal lumen.

Obstruction of the esophagus can form in utero. This pathology is congenital.

Symptoms

Dysphagia is the main sign of pathology. It manifests itself as difficult, painful and incomplete swallowing. Various degrees are possible - from mild discomfort to choking even with water.
Odynophagia, manifested as severe pain when swallowing with a location behind the sternum. Pain may appear on the left under the scapula, at the bottom of the jaw apparatus. Sometimes the symptoms become similar to a heart attack.
Vomiting previously eaten food containing blood.
Belching with a sharp unpleasant smell, like rotten eggs.
Weight loss due to reduced food portions, but maintaining appetite.

Diagnostics

Pathology is diagnosed by using imaging (optical) detection methods, such as:

Eophagogastroduodenoscopy is an instrumental technique for assessing the condition of the esophageal lumen, the structure of the epithelium, and taking a biopsy;
Ultrasound is a method that detects any pathology of the esophagus;
CT and MRI are techniques that allow one to differentiate pathology, confirm the diagnosis and identify associated problems.

Obstruction of the esophagus causes changes in clinical parameters, so additional tests such as:

grade color index blood and the degree of decrease in hemoglobin in red blood cells;
determination of total hemoglobin, protein;
conducting a fecal examination for occult blood.

Treatment

Therapeutic tactics depend on why the pathology arose, as well as on the degree of its development. When a foreign particle gets stuck in the esophagus, it is removed through an esophagoscope with bougienage (expansion) of the narrowed lumen. In case of esophageal dysfunction due to the development of oncology, surgical methods are used. The affected part is removed, and the remains are attached directly to the stomach. Additionally, radiation, chemical or photodynamic therapy.

Medication

The assignment is made:

antacids;
prokinetics;
astringents;
regeneration stimulants;
proton inhibitors.

Surgical

Most often used for esophageal cancer. There are several popular techniques:

surgery with complete excision of the esophagus and its replacement with other tissues;
chemotherapy with anticancer drugs;
radiation combined with chemotherapy to shrink the tumor so that it can be removed.

If the obstruction is caused by a benign neoplasm, the pathology is eliminated by bougienage, that is, dilation of the esophagus with special instruments. When treating cardiospasm, surgery is not necessary; conservative methods are used.

Traditional methods

The combination of conservative techniques with folk remedies gives positive result in the treatment of esophageal obstruction. But the use of alternative medicine recipes must be agreed with your doctor.

Oak bark decoctions

You need to take 30 g of cinquefoil bark and root, 40 g of leaves walnuts and St. John's wort, 20 g of oregano. The mixture should be crushed, take 30 g and pour 700 ml of chilled water. The drink is infused for 3 hours. After the time has passed, the tincture is brought to a boil and cooked for 5-10 minutes. After filtering, the medicine should be drunk 100 g 30 minutes before meals.

“GERD occurs when a person, as a result of constant reflux of very caustic contents of the stomach (acidic) or small intestine (alkaline) back into the esophagus, inflames the mucous membrane of its lower section. – Says gastroenterologist Oleg Vasilchenko.

The symptoms of GERD are familiar to many. This is heartburn, belching sour or bitter, a feeling of a lump behind the sternum, increased salivation, discomfort when swallowing, up to pain in the esophagus, and sometimes even retrosternal pain like angina pectoris.

Today it is known that GERD can cause serious complications in the form of ulcers (sometimes bleeding), narrowing of the esophagus and precancerous changes in the esophageal mucosa. The disease aggravates and provokes attacks of asthma, angina pectoris, and can cause severe caries and pneumonia.

What happens inside a person can be described as follows. During normal operation of the esophagus, food passes through it into the stomach gradually and sequentially. And if intestinal motility (contraction of the muscles of the esophagus, which helps food move from the pharynx to the stomach) is disrupted, the esophagus contracts so that pieces of food dangle back and forth along it and reach the stomach much later than they should.

Insufficiency of the cardia (sphincter of the lower part of the esophagus) is expressed in the fact that the “passage” from the stomach to the esophagus is not always closed for those pieces of food that “ask” back and, as a result, part of the lunch again ends up in the esophagus, which should not happen.

On motor activity esophagus and sphincter tone have a bad effect on many food products(alcohol, fats, coffee, chocolate, citrus fruits) and some medications (nitrates, barbiturates, tranquilizers, theophylline, calcium channel blockers, etc.).

The mucous membrane of the esophagus is damaged when:

The stomach is stretched by food due to overeating or as a result of aerophagia (overflow with air);

Peptic ulcer or cholelithiasis is present;

Pregnancy is present and fetal growth increases intra-abdominal pressure;

The person suffers from mental instability.

A patient with GERD needs to give up smoking, wearing tight clothes, lifting heavy objects, alcohol, fats, coffee, and dinners before bedtime. After eating, it is equally harmful to do exercises and go to bed.

You need to replace the waist belt with suspenders, sleep in bed with the head of the bed raised, preferably on the left side, lose excess weight, adjust your chair and eat in moderation.

Experience shows that the medicinal method GERD treatment more effective than surgery. But even when cured with drugs, the disease returns in 85-90% of patients after six months, usually due to the fact that people do not want to change their lifestyle.

Fibroesophagogastroscopy can detect and confirm the diagnosis of GERD - you swallow a flexible hose, at the end of which there is a light bulb and a lens that allows you to examine the esophagus and stomach from the inside.

Food does not pass into the stomach

Either you are worried about your health, or your health will worry you!

Achalasia cardia. If food doesn't pass.

This disease occurs due to the lack of peristalsis of the esophagus or when the cardia (the junction of the esophagus into the stomach) does not open reflexively during swallowing. Food masses accumulate in the esophagus, causing its significant expansion.

You need to eat often, once a day and little by little. This will reduce the frequency of regurgitation, which occurs mainly when the esophagus is full. Eat slowly, chew your food thoroughly, and do not talk while eating. After eating, be sure to drink a glass or half a glass of warm boiled water to remove food debris from the esophagus. A few sips of water push the retained food bolus into the stomach, protecting the esophagus from the development of congestive inflammation. Useful and mineral water, since, releasing a large amount carbon dioxide, they increase pressure in the esophagus, thereby pushing food into the stomach faster.

With achalasia cardia, there are all the prerequisites for retention of foreign bodies in the esophagus. Therefore, be especially careful when there are bony fish or poultry on the table.

Food does not pass into the stomach

In diseases of the esophagus, the main complaints will be difficulty passing food through the esophagus (dysphagia) and pain along the esophagus (behind the sternum). Already at the first complaint of this kind, you should consult a doctor and conduct an examination.

It is advisable to remember the term “reflux esophagitis”. Reflux is a reverse reflux, in our case the reflux of gastric contents into the esophagus; normally this should not happen, since there is a muscular valve between the esophagus and the stomach. Esophagitis is inflammation of the esophagus. Thus, reflux esophagitis is an inflammation of the esophagus due to the reflux of acidic gastric contents into it (see diagram).

Esophageal cancer occurs more often in people with risk factors for the disease. These include systematic contact with carcinogenic substances, chronic radiation exposure, excessive consumption of rough, very hot, spicy food irritating the mucous membrane of the esophagus, alcohol abuse, smoking. Precancerous diseases include inflammation of the esophagus, polyps and papillomas of the esophagus, scars after chemical burns. Local signs of esophageal cancer include dysphagia, chest pain, a feeling of fullness behind the sternum, regurgitation of food, and increased salivation. Along with these signs, increasing weakness and weight loss are noted.

A functional disorder of the esophagus is a violation of its motor function without visible organic (inflammatory, tumor) changes. Most often this is manifested by periodically occurring spasms of the esophagus. The causes of this type of disorder are mostly related to emotional disorders - increased level human anxiety, persistent depression of mood (depression), household and work-related psychotraumatic factors. In some cases, the reasons cannot be determined.

Hiatal hernia - chronic illness, in which the esophagus, stomach, and rarely intestinal loops are displaced into the chest cavity through an opening in the diaphragm (see diagram). A hiatal hernia contributes to the development of inflammation of the esophagus (reflux esophagitis). A common sign Hiatal hernias are pain behind the sternum, in the epigastric region, in the left half of the chest. Pain appears after eating, during physical activity, horizontal position, with a cough, against the background of bloating. Relieves pain after belching, regurgitation, vomiting, and drinking soda. We must remember that pain with a hiatal hernia requires special attention, since they are similar to the pain of angina pectoris, peptic ulcer, chronic pancreatitis. A hiatal hernia is often combined with these diseases. Patients also complain of heartburn, pain when swallowing, and disturbances in the movement of food through the esophagus. In some patients with hiatal hernia, gastric contents from the esophagus enter the Airways. A cough appears, there may be shortness of breath, bronchitis and pneumonia occur. A hiatal hernia is recognized using an x-ray. It is necessary to examine the patient not only “standing”, as is usually done, but always in the “lying” position. Treatment of a hiatal hernia is aimed primarily at preventing an increase in intra-abdominal pressure. It is necessary to avoid heavy lifting, frequent bending forward, and tightening the belt. You should sleep with the head of the bed raised. Dietary measures are important. Meals should be at least 4 times a day, dinner 2-3 hours before bedtime, eat slowly. It is necessary to limit the consumption of hot, spicy foods, foods that reduce the tone of the lower esophageal sphincter - coffee, chocolate. Drug treatment is the same as for reflux esophagitis. In cases of severe disease, surgical intervention is used. A patient with a hiatal hernia should be observed by a gastroenterologist.

Esophageal diverticula are limited sac-like protrusions of the esophageal wall, facing outward (see diagram). Diverticula can be single or multiple. They are formed in people with greater compliance of the walls of the esophagus than in healthy people as a result of increased pressure inside the esophagus or “pulling” of the esophagus from the outside by adhesions. Very often, diverticula of the esophagus do not manifest themselves; they are detected by chance during x-ray examination. With high-lying diverticula, there may be a cough, a feeling of dryness in the throat and a feeling of a foreign body along the esophagus when swallowing. In patients with very large diverticula, there are disturbances in the movement of food through the esophagus, regurgitation, night cough. After recognizing diverticula, a gastroenterologist decides on the method of treatment. Regime and diet are of great importance. The food you eat should be crushed, you should eat slowly, in small portions. After eating, it is advisable to drink a few sips of water. You should sleep with the head of the bed raised. It is advisable to take one teaspoon before meals vegetable oil. An inflammatory process called diverticulitis can occur in diverticula. In these situations, antibiotics are prescribed for a course of 5-8 days with a break of 10 days. If treatment is insufficiently effective, indications for surgery are given.

Achalasia is an enlargement of the esophagus that develops due to a decrease or inability of the lower esophageal sphincter to relax during the act of swallowing, combined with a decrease in the force of contraction of the esophagus. Among the causes of esophageal achalasia are the consumption of very cold food, cold drinks, vitamin B1 deficiency, as well as frequent stressful situations and psychoemotional disorders. At the initial stages, the disease can be considered as purely functional, but over time, persistent changes are detected in the nerve cells of the middle and lower thirds of the esophagus. The main symptom of achalasia is difficulty swallowing. They vary in severity and intensity, and it is equally difficult to swallow both liquid and solid food. Patients also complain of chest pain. Pain can occur directly during swallowing, as well as outside of eating. Typical of achalasia is regurgitation. Esophageal achalasia is recognized using x-ray and esophagoscopy. More complex diagnostic methods are also used. In most cases, treatment for achalasia begins with general events, especially in the initial stages of the disease. If possible, you should avoid stressful situations and negative emotions. Food should be mechanically and chemically gentle, i.e. crushed, not spicy, with enough proteins and vitamins. Food should be taken 6 times a day, in small portions. Drug treatment is carried out with prolonged nitrates and calcium antagonists (verapamil and nifedipine). The course of treatment is usually 1 month; if it is insufficiently effective, instrumental expansion of the lower esophagus is performed.

What to do if food gets stuck in the throat and does not pass into the stomach?

It is necessary to consult a gastroenterologist and undergo an examination of the esophagus - x-ray, endoscopic - to exclude various tumor diseases. Quite often, with these complaints we are talking about achalasia cardia - a violation of the transition of food mass from the esophagus to the stomach.

The cardia is the junction of the esophagus and the stomach. If the peristalsis of the esophagus is impaired and the cardia does not open reflexively during swallowing, then the food mass is forced to linger in the esophagus itself, causing its expansion. This leads to regurgitation and pain in the sternum.

Causes of diseases associated with central dysfunction nervous regulation motor function of the esophagus, long-term nervous overload, stressful situations, and sometimes burns of the esophagus.

Food should not be too hot or too cold. Spicy seasonings and sauces are excluded from the diet.

If the disease worsens, the attending physician may advise introducing weak meat broth and side dishes of pureed vegetables - carrots, beets, cauliflower - into the diet for a certain period; various porridges - semolina, rice, Hercules; meat and fish - in minced form (boiled meat minced through a meat grinder, cutlets, dumplings, soufflé). Various vegetables and fruit juices, compotes, jelly.

Caution must be exercised if there is bony fish or chicken on the dinner table. Swallowed bones can linger in the esophagus and cause inflammation or even damage to the mucous membrane of the esophagus.

Sometimes, to facilitate the passage of food through the esophagus, deep holes can be made several times. breathing movements, bend the shoulder part of the body back.

Difficulty passing food through the esophagus

A condition in which a person experiences pain when food passes through the esophagus, or other discomfort associated with swallowing, is called dysphagia. This is not an independent nosological unit, but only a symptom, and quite a formidable one, of several diseases at once.

Dysphagia is characterized by difficulty or inability to swallow

The esophagus is part of the digestive canal, which is a muscular tube somewhat flattened from front to back. Food enters it from the pharynx and, after passing through it, enters the stomach. Its length in adults is about thirty centimeters. It begins as a continuation of the pharynx, passes through the chest cavity and ends in the abdominal cavity.

Etiology of this problem

The reasons why food cannot pass through the esophagus normally are quite varied. They may be associated with damage:

Throats.
Esophagus.
Stomach.
Tissues surrounding the esophagus.
The presence of foreign bodies in these formations.

From the outside oral cavity and the initial part of the esophagus, the main causes of dysphagia may be oral candidiasis, tonsillitis with pronounced enlargement of the tonsils, as well as a previous cerebral stroke. Sometimes it can be one of the symptoms of Parkinson's disease, pseudobulbar palsy, or polio.

Thus, etiological factors are extremely varied, as in the case of snoring during pregnancy, its causes may be associated with disruption of the activity of many organs and their systems.

Classification of dysphagia

There are several criteria by which dysphagia is divided into types. For example, based on the location of the pathological process that caused it, the following types of this symptom are distinguished:

There is also a division of dysphagia into organic, that is, caused by objective pathological changes in organs and tissues, and functional, in which the cause of difficulty swallowing is transient disorders of the nervous regulation of the muscular apparatus of the esophagus.

They also consider the division into a paroxysmal, or attack-like form, the causes of which lie in a disorder of the nervous regulation of esophageal motility, and a constant form, which occurs in patients with organic lesions of this organ.

Clinical picture

Thus, unpleasant process swallowing indicates that a person has a pathology of one of the gastrointestinal tract organs, and it is necessary to consult a doctor. In parallel with the feeling that food is not passing well through the esophagus, patients may develop a number of accompanying symptoms that help establish the diagnosis. They experience pain when swallowing, after which coughing attacks or even suffocation may develop. Their voice becomes hoarse and hoarse.

Patients with dysphagia may experience a lump in the throat

Many patients complain of increased salivation. Between meals, people with dysphagia may experience a feeling of fullness behind the sternum or a feeling of a lump in the throat. Initially, people experience these unpleasant sensations if the food they eat is hard and rough. However, as the disease progresses, the condition worsens, and patients cannot eat even soft and then liquid foods normally.

When swallowing impairment is a consequence of paralysis of the pharyngeal muscles, or esophageal fistula, patients experience severe regurgitation, in which food enters the nose and trachea. With lesions of the lower esophagus (achalasia cardia, esophagitis, reflux disease, stricture), severe vomiting is observed, after which the discomfort disappears or its intensity noticeably decreases.

The voice of such patients becomes hoarse or even hoarse, which indicates damage to the larynx or pharynx. They lose body weight. Its rapid decline should alert doctors, as it may be a sign of esophageal cancer, which prevents food from passing into the stomach.

Dependence of the clinical picture on the location of the obstruction to the passage of food

With the first type of dysphagia, food accumulates in the mouth of the patient, who cannot swallow it. If the act of swallowing occurs, then subsequent unpleasant sensations arise almost instantly, no more than one second passes. Aspiration of food (its entry into the upper respiratory tract) is very often observed, resulting in coughing and suffocation.

In the case of esophageal dysphagia, people feel that food stops somewhere behind the breastbone, and these sensations arise only after a few sips.

From the moment of the last of them, two seconds pass (obstacle at the level cervical spine) up to 4-5s (pathological process in the middle third). If the obstacle is in the lower part of the esophagus, the clinic develops in 8-9 seconds.

Diagnostics

The scope and nature of examinations are determined by the attending physician

Because the reasons causing disturbance The passage of food through the esophagus is extremely diverse, then the diagnosis must be multifaceted. Correct collection of anamnesis of the disease plays a very important role. This stage must be approached responsibly, since even small parts can play an important role.

When the information is collected, doctors move on to an objective examination. At this stage it is important to correctly assess general status patient, which may change due to systemic diseases. Oral examination also plays an important role. It allows you to identify stomatitis, as well as inflammatory diseases, such as sore throat.

From instrumental methods The most informative diagnostic method is fibrogastroduodenoscopy.

This endoscopic method research, which allows you to assess the condition of the mucous membrane throughout the esophagus, as well as the stomach and duodenum. In this case, it is possible not only to examine the pathological formation, but also to collect biological material for analysis, which is very useful if a neoplasm is suspected.

X-ray diagnostic methods are very useful for assessing the condition of the mediastinum. With their help, you can also study the structural features of the patient’s esophagus, evaluate its size and shape, as well as the condition of the mediastinal tissues. During an X-ray examination, it is easy to identify external tumors that develop outside the esophagus and lead to its mechanical compression, which makes it difficult for food to pass through it.

If a disorder of the nervous regulation of esophageal tone is suspected, a detailed examination should be carried out neurological examination, which can also be combined with laboratory, x-ray techniques, for example, computed tomography or magnetic resonance imaging.

In order to clarify the possibility of esophagitis and reflux disease, a pH-metry technique is used to determine the acidity of gastric juice.

Therapeutic tactics

Treatment is aimed at the underlying disease that caused dysphagia

Because the this violation has extremely diverse causes and development options, there is no single treatment plan for it. Help should be based on correct and complete diagnosis and treatment of the underlying disease. You also need to take into account that the process may be functional in nature and require a completely different approach.

If the process is functional, you should only explain to the patient the causes and pathogenesis of his problem, and recommend avoiding unnecessary stress, mental and physical strain, and normalizing sleep and diet.

If there is a spastic nature of dysphagia, the use of a number of muscle relaxants is indicated, which help normalize muscle tone and improve the patient’s condition.

If it is determined that the cause of impaired swallowing is a third-party pathology, it should be treated. For example, adequate therapy should be prescribed for GERD or esophagitis.

Diseases of the esophagus

The esophagus is of invaluable importance in the human body. It is thanks to him that we receive everything we need for the functioning of other organs, because the food we consume gives us energy for life. But this organ, like our entire body, is subject to diseases that not only bring pain, but are also psychologically difficult to bear, as they are accompanied by belching, heartburn, and an unpleasant odor. Such diseases affect not only the health of the entire body, but also the daily life of the patient. The most common diseases of the esophagus are caused by impaired motility of the organ or neoplasms, such as cysts and benign tumors, and cancer. About the main diseases of the esophagus, their symptoms, diagnosis and treatment, we'll talk Further.

Diseases of the esophagus and their symptoms

Motility disorders of the esophagus include diseases such as achalasia cardia, esophageal spasm of the esophagus, peptic esophagitis, chalasia cardia and diaphragmatic hernia. These diseases have slightly different course patterns and symptoms.

Achalasia cardia, or cardiospasm, is a neuromuscular disease. This is a violation of the reflex opening of the lower esophageal sphincter during the passage of food. The reasons for the development of this disease of the esophagus are not known; it manifests itself in adulthood, more often in women. Complications of this disease are most often caused by prolonged retention of food in the esophagus. In adults, a common complication is inflammation of the esophagus, which in turn can cause cancer of both the esophagus itself and upper section stomach. Children more often experience complications such as bronchopneumonia, lung abscesses and other respiratory diseases caused by food getting into them.

Symptoms of achalasia are triadic. The first manifestation of this disease of the esophagus is a swallowing disorder, or dysphagia. This symptom may occur suddenly or gradually, becoming worse after nervous excitement. In some cases, paradoxical dysphagia is observed, when hard and dense foods pass normally, but liquids do not. Swallowing problems may also depend on the temperature of the food. The second symptom of achalasia is regurgitation, which occurs when the esophagus is full, when a sharp muscle contraction occurs. The third symptom is pain caused by spasm of the esophagus muscles when it is full. Pain behind the sternum goes away after food passes into the stomach. These symptoms are also accompanied by nausea, belching of air, burning in the esophagus, and increased salivation.

Esophageal spasm - spasm of the walls of the esophagus, not accompanied by dysfunction of the lower alimentary sphincter, occurs due to nervous disorder. Esophagospasm most often occurs in middle-aged and elderly men, and may also be a symptom of other digestive tract disorders.

A symptom of esophageal spasm of the esophagus is chest pain, which is often mistaken for manifestations of angina pectoris. Pain can occur not only during meals, but also in the interval between meals. They come in varying intensity and duration. Except pain this disease is characterized by a paradoxical swallowing disorder; the inconsistency of this symptom distinguishes esophageal spasm from other diseases and neoplasms of the esophagus.

Peptic esophagitis, or reflux esophagitis of the esophagus, is caused by insufficiency of the lower alimentary sphincter, which leads to the reflux of stomach contents back into the esophagus. Chalazia cardia has the same course, but it is more often caused by hiatal hernia. Due to such emissions of gastric juice, bile, and pancreatic juice, the mucous membrane of the esophagus suffers. Inflammation and ulcers occur, with scarring of which the esophagus narrows. This disease of the esophagus proceeds very slowly, in frequent cases it can be found in infants.

Symptoms of reflux esophagitis are burning behind the sternum, heartburn, pain, belching. Some symptoms worsen when bending over, lying down, smoking or drinking alcohol. Belching can cause aspiration pneumonia. This happens when gastric contents enter the respiratory tract, especially during night regurgitation, which is accompanied by coughing. Complications of the disease may include bleeding and scarring.

Diaphragmatic hernia - movement of an organ from abdominal cavity into the chest cavity. Hernias can be congenital, acquired or traumatic defects; most often, patients have hiatal hernias; they can be sliding or paraesophageal. This disease has a very scant symptoms. The main symptoms of a diaphragmatic hernia are anemia and hidden bleeding.

Benign tumors of the esophagus grow slowly and are practically asymptomatic. Most often they are discovered by chance; in some cases, the patient may experience an increasing difficulty in swallowing, which develops over several years.

Unlike benign tumors and cysts, esophageal cancer has more severe symptoms and is diagnosed many times more often than other diseases of the esophagus. Cancer occupies 60-80% of all diseases of the esophagus, it is the sixth most common disease among adults, and is more common in men of this age. age groups smoking and alcohol abusers. Here are a few more reasons that cause esophageal cancer: complications of impaired motility of the organ, namely achalasia, Barrett's esophagus, papillomas and scars, which can also occur after a burn of the esophagus with caustic substances.

First, esophageal cancer manifests itself as a feeling of discomfort and chest pain in the patient, dysphagia, increased salivation, and weight loss. For the first one or two years, symptoms of esophageal cancer are practically not observed, until the tumor begins to narrow the esophagus, dysphagia gradually increases, and pain intensifies.

Diagnosis of esophageal diseases

Diagnosis of esophageal diseases early stages carried out using esophagotonocymography. The esophagus is examined using a multi-channel probe with balloons or open catheters, which record contractions of the esophagus and changes in pressure in it. Most often, such a study is performed when symptoms of achalasia are detected.

X-ray examination makes it possible to detect deformations of the esophagus due to spasm of its muscles. Such studies are prescribed for suspected esophagospasm, reflux esophagitis of the esophagus, diaphragmatic hernia and neoplasms of the esophagus. For symptoms of reflux esophagitis, intraesophageal pH-metry and esophagomanometry are prescribed, which makes it possible to establish the pH level in the lower esophagus and dysfunction of the lower esophageal sphincter. To detect gastroesophageal reflux, a barium x-ray is sometimes prescribed, with the patient in a supine position with the leg end elevated.

Of course, an important role in diagnosing diseases of the esophagus is played by a patient interview, which the attending physician must conduct before prescribing any examination. Many symptoms of esophageal diseases can be a manifestation of other diseases. Therefore, it is very important to make sure that these are not diseases of the digestive system that require urgent surgical intervention.

Treatment of esophageal diseases

Conservative treatment of esophageal diseases is prescribed for initial stages diseases such as achalasia cardia, reflux esophagitis and uncomplicated diaphragmatic hernia Oh.

For achalasia, nitro drugs, ganglion blockers, nifedipine and others are prescribed similar drugs calcium antagonists. But the main method of treating this disease is cardiolatation. This method involves widening the narrowed area in the esophagus using a balloon pneumatic cardiodilator. This treatment of achalasia is contraindicated in patients with portal hypertension, which is accompanied by varicose veins of the esophagus, in patients with severe esophagitis and blood diseases. In case of contraindications, alternative methods are used.

Conservative treatment of esophagospasm consists of a gentle diet, prescription of nitro group drugs, sedatives and antispasmodics. With absence positive effect carry out surgery which involves cutting the muscle layer of the esophagus. It is important to start treatment as soon as the first symptoms of esophageal spasm of the esophagus appear, since in this case there is a possibility of avoiding surgical treatment much higher.

Treatment of reflux esophagitis is aimed at reducing intra-abdominal pressure, manifestations of esophagitis, and reducing body weight to the age norm. IN mandatory a mechanically and chemically gentle diet and fractional meals are prescribed. H2-receptor drugs are prescribed: ranitidine, famotidine, which reduce the acidity of gastric juice, and antispasmodics and enveloping agents are also prescribed. Prokinetics are used to increase the force of compression of the lower esophageal sphincter and the time of evacuation of gastric contents. Surgical treatment prescribed for axial hiatal hernia, bleeding and stenosis.

Treatment of sliding diaphragmatic hernias is carried out conservatively, reducing the manifestations of the gastroesophageal reflex. Surgical treatment is performed for complications such as bleeding, narrowing of the esophagus, or ineffectiveness of conservative treatment. The latter complication is more common in patients with birth defects and insufficiency of the lower esophageal sphincter.

Talk about conservative treatment There is no esophageal cancer. This happens due to the diagnosis of the disease at those stages when it does not produce a positive effect. Radical treatment carried out directly as preparation before surgery. In the early stages of the disease, pure radiation treatment or surgery has a positive effect, in later stages only a combination of both.

The use of chemotherapy and radiation therapy before surgery improves treatment results several times. Irradiation is carried out several weeks before surgical treatment, and the method of remote gamma therapy is used. Surgical intervention depends on the location of the malignant tumor. If the lower part of the esophagus is affected, it is removed together with top part stomach, sewing the remaining part of the esophagus into the stump of the stomach. If the middle section is affected, the esophagus is completely removed; the stomach wall is first sutured to the abdominal wall and an anastomosis is created to introduce nutrition through a tube.

One to two years after removal of the esophagus, provided there is no relapse, the esophagus is restored, replacing it with the small intestine. Relapse of the disease can occur if radiation therapy is ineffective. The lethality of this disease is associated not so much with metastasis as with the depletion of the body due to the primary tumor. Therefore, the sooner it is discovered malignant disease esophagus and surgery is performed, the more successful the treatment prognosis.

Obstruction of food through the esophagus

Of the three parts of the human esophagus, the thoracic section suffers from obstruction. It is more often susceptible to tumor damage and trauma. The pathological process is accompanied by dysphagia, that is, a violation of swallowing function. This occurs due to an abnormal narrowing of the lumen of the esophagus, which prevents the normal passage of solid foods and liquids.

Injuries to the thoracic region can cause obstruction of the esophagus.

Description of the pathology

When a wound, crack or scratch heals, connective tissue forms on the walls of the digestive tract, forming a seal. This scarring causes narrowing of the lumen.

Less commonly, obstruction of the esophagus occurs against the background of the development of cancer in its wall. External compression of the tract by nearby pathological tissues is also possible.

Stages

a person feels discomfort when swallowing. Unpleasant, poorly expressed sensations arise behind the sternum;
It becomes difficult to swallow pieces, solid food does not pass well. Relief occurs when drinking water;
it is difficult to eat pureed, pureed and porridge-like food, it also does not pass well;
pain when swallowing occurs when drinking any liquids and drinking water;
the critical stage, when complete obstruction occurs, not allowing even water to be consumed.

Forms

Narrowing of the esophagus of benign origin. Appears against the background of chemical burns, intentional or accidental use of cauterizing liquids, untreated ulcers in the deep layers of the mucous membrane of the esophageal walls.
Stenosis of malignant origin. Appears with esophageal cancer.

These two forms have 4 degrees:

1st degree, when the size of the narrowing in diameter is 9-11 mm;
2nd, when the diameter is 6-8 mm;
3rd - 3-5 mm;
4th - 1-2 mm.

Causes

Causal factors for obstruction can be caused by organ diseases and injuries. The most common cases:

development of deep ulcers in the epithelium of the esophagus;
the presence of saccular protrusions in the walls of the organ - diverticula;
the appearance of cardiospasm, that is, narrowing of the alimentary tract in the area of its connection with the stomach;
the development of benign and malignant tumors with a cell type that is the same or different from those that form the organ;
the onset of gastroesophageal reflux, characterized by the release of gastric contents back into the esophagus;
development of ulcerative esophagitis, that is, inflammation of the mucous membrane with the appearance of deep defects;
consumption of aggressive liquid chemicals (acids, alkalis), hot food and drinks that cause burns with stenosis;
ingress of foreign particles;
open wounds and closed injuries;
mechanical damage;
consequences of severe infections such as tuberculosis, fungal mycosis;
the presence of systemic connective tissue diseases, for example, with damage to blood vessels, various organs and tissues, which causes the proliferation of fibrous tissue with a decrease in the esophageal lumen.

Obstruction of the esophagus can form in utero. This pathology is congenital.

Symptoms

Dysphagia is the main sign of pathology. It manifests itself as difficult, painful and incomplete swallowing. Various degrees are possible - from mild discomfort to choking even with water.
Odynophagia, manifested in the form of severe pain when swallowing, located behind the sternum. Pain may appear on the left under the scapula, at the bottom of the jaw apparatus. Sometimes the symptoms become similar to a heart attack.
Vomiting previously eaten food containing blood.
Belching with a strong unpleasant odor, like rotten eggs.
Weight loss due to reduced food portions, but maintaining appetite.

Diagnostics

Pathology is diagnosed by using imaging (optical) detection methods, such as:

Eophagogastroduodenoscopy is an instrumental technique for assessing the condition of the esophageal lumen, the structure of the epithelium, and taking a biopsy;
Ultrasound is a method that detects any pathology of the esophagus;
CT and MRI are techniques that allow one to differentiate pathology, confirm the diagnosis and identify associated problems.

Obstruction of the esophagus causes changes in clinical parameters, so additional tests such as:

assessment of the color index of blood and the degree of decrease in hemoglobin in red blood cells;
determination of total hemoglobin, protein;
conducting a fecal examination for occult blood.

Treatment

Therapeutic tactics depend on why the pathology arose, as well as on the degree of its development. When a foreign particle gets stuck in the esophagus, it is removed through an esophagoscope with bougienage (expansion) of the narrowed lumen. In case of esophageal dysfunction due to the development of oncology, surgical methods are used. The affected part is removed, and the remains are attached directly to the stomach. Additionally, radiation, chemical or photodynamic therapy is prescribed.

Medication

antacids;
prokinetics;
astringents;
regeneration stimulants;
proton inhibitors.

Surgical

Most often used for esophageal cancer. There are several popular techniques:

surgery with complete excision of the esophagus and its replacement with other tissues;
chemotherapy with anticancer drugs;
radiation combined with chemotherapy to shrink the tumor so that it can be removed.

Traditional methods

The combination of conservative methods with folk remedies gives a positive result in the treatment of esophageal obstruction. But the use of alternative medicine recipes must be agreed with your doctor.

Oak bark decoctions

You need to take 30 g of cinquefoil bark and root, 40 g of walnut and St. John's wort leaves, 20 g of oregano. The mixture should be crushed, take 30 g and pour 700 ml of chilled water. The drink is infused for 3 hours. After the time has passed, the tincture is brought to a boil and cooked for 5-10 minutes. After filtering, the medicine should be drunk 100 g 30 minutes before meals.

Wormwood collection

Together with wormwood, arnica and ground femoris root are used, taken in a ratio of 50: 75: 100, respectively. After thorough mixing, 45 g of the mixture is selected, placed in a thermos, into which 400 ml of boiling water is added. The drink is filtered after 10 hours. You should drink it in small sips of half a glass four times before meals (30 minutes before).

Other settings

When treating pathology with folk remedies, tinctures are used:

with lemongrass;
marshmallow root;
ginseng;
alder cones and quince seeds;
Rhodiola extract.

Diet therapy

The diet is based on the individual characteristics of the body, the degree of stenosis and the provoking causes. Three dietary tables are widely used:

No. 1, suggesting a full menu including pureed dishes, steamed or boiled. Hot and cold foods are excluded. You should eat small portions up to 6 meals.
No. 1a, which involves the consumption of warm liquid and semi-liquid dishes up to 6 times a day with breaks of 2.5 hours. The amount of salt is limited, the volume of water is increased to 1.5 liters. Additionally, foods high in vitamins are introduced: A, B6, B12, C. It is not allowed to eat bread, baked goods, vegetables, sausages, smoked meats, fatty meats, canned food, sweets, sour fruits and berries, coffee with strong tea, and soda.
No. 1b, suggesting a complete low-calorie menu with a limitation of chemically, thermally, and mechanically irritating foods to the mucous membrane. Food should be ground and boiled. Consistency - liquid, mushy. Meals are fractional.

In all three cases, a snack is allowed 3 hours before a night's rest.

Who treats the disease?

If you experience the first difficulties and discomfort when swallowing food or water, you should contact a specialist - a gastroenterologist.

Esophageal dysphagia is a disease whose main symptom is difficulty swallowing food. In particularly severe cases, swallowing food can cause pain and cramping.

About a quarter of patients suffer from functional dysphagia, three quarters from organic dysphagia. In 10% of cases, surgical treatment is required. The passage of food through the esophagus is affected by its diameter, the size of the food bolus, and the state of the swallowing center. It is the swallowing center that is responsible for relaxing the muscles of the esophagus and regulating their contractions. When swallowing healthy esophagus increases in diameter up to 5 cm. Stretching to a diameter of less than 2.5 cm indicates the presence of dysphagia.

Causes of esophageal obstruction

If the bolus of food has too much big sizes, mechanical blockage of the esophagus occurs. The same thing can happen when the lumens of the upper section are compressed digestive system outside. Motor dysphagia occurs with diseases of the muscles responsible for swallowing, with disorders of the nervous system, uncoordinated work of the esophageal muscles, and depression of the respiratory center of the brain. The causes of esophageal obstruction may vary. For staging accurate diagnosis and appointments proper treatment you need to find out the reasons for the difficulty swallowing food. The first step is to identify the place where food bolus is retained. Depending on this, dysphagia can be oropharyngeal or esophageal.

Oropharyngeal dysphagia is caused by paralysis of the laryngeal muscles as a result of encephalitis, rabies, botulism, or pseudobulbar palsy. Dysphagia also occurs with endocrine pathologies: diabetes mellitus, hypothyroidism, dermatomyositis; inflammatory processes: sore throat, tonsillitis, infectious pharyngitis, abscesses. Tumors and mechanical damage also contribute to the development of esophageal obstruction.

The main symptom of oropharyngeal dysphagia is the accumulation and retention of food after a swallow. In this case, the patient may inhale food particles, resulting in choking and severe coughing. When food enters the sinuses, nasal congestion and photophobia occur. The patient notes general weakness and increased fatigue.

Esophageal dysphagia also occurs when there is cervical osteochondrosis and hernias. In addition, the tone of the esophageal muscles and their motility can be impaired by spasms, dilatation of the esophagus, diverticulosis, and Parkinson's disease. With benign and malignant tumors of the digestive tract, a narrowing of the swallowing canal occurs. This also contributes to varicose veins. Esophageal blockage can also occur during inflammatory processes, chemical burns, spikes after surgical interventions, Crohn's disease, enlarged lymph nodes.

Symptoms of esophageal dysphagia

The first sign is difficulty swallowing, food seems to get stuck in the throat or behind the sternum. The patient, as a rule, cannot determine the place where the food gets stuck. You can recognize it in the following way: if food gets stuck about a second after swallowing, the blockage is localized in the cervical esophageal canal; if after 5 seconds, then in the middle part; after 8 seconds, the obstruction has occurred in the distal esophagus.

Determining the location of esophageal blockage makes it easier to diagnose diseases that lead to pain and heaviness in the chest. If the patient suffers from dysphagia of the cervical esophagus, determining the location of the obstruction does not play a big role, because the disease can be caused by damage to any part of the esophagus. Signs of dysphagia are also divided by duration: persistent and paroxysmal. In the first case, the pathology has organic nature, the patient has difficulty swallowing food. In the second case, the main factor is hypermotor dyskinesia of the esophagus, which occurs with hernias, large tumors and inflammatory processes.

The last stage of the disease is aphagia - complete obstruction of the esophagus, requiring emergency care. It develops when the lumen of the esophageal tube is completely closed. Treatment in this case consists of emergency surgery. Dysphagia can also develop with pathologies of the nervous system (hysterical lump and phagophobia). A phobia may occur due to fear of food getting into the respiratory tract or pain when swallowing food. This usually happens with laryngeal paralysis and rabies. With hysterical phagophobia, the patient may completely refuse to eat.

It is very important to take into account the accompanying symptoms when diagnosing the disease. A fistula or paralysis of the muscles of the pharynx can lead to food entering the sinuses and bronchi. Cancerous tumors accompanied sharp decline patient's weight. If a person begins to lose his voice, the cause must be sought in pathologies of the larynx. If voice loss occurs already with existing dysphagia, the inflammatory process is localized in the esophagus. Hoarseness occurs when the tumor penetrates into vocal cords. If dysphagia is accompanied by hiccups, then the cause should be sought in the distal esophagus.

Adhesions in the esophagus are usually accompanied by vomiting. After vomiting, the patient's condition improves, because... with this disease, he experiences heaviness behind the sternum after swallowing food. The lower the source of pathology is located, the more profuse the vomiting will be. Paralysis of the laryngeal muscles is accompanied by loss of sensitivity of the tongue and active contractions of its muscles.

Treatment of esophageal obstruction

The selection of a course of treatment directly depends on the reasons that caused such a symptom.

In case of functional dysphagia, the patient needs to be explained how to eliminate the pathology, give recommendations on proper nutrition and cupping psychological reasons leading to the development of the disease. Patients with hysterical dysphagia are recommended to take antidepressants. For spasms of the esophageal muscles, injections of botulinum toxin, muscle relaxants, or surgical dilation of the esophageal canal are performed.

When treating organic dysphagia, it is first necessary to eliminate the factors leading to impaired motor skills. This is done with the help of drugs that inhibit or stimulate muscles.

If dysphagia is accompanied by hypermotility of the digestive tract, treatment should include antispasmodics. Treatment of dysphagia of any origin has its own characteristics, for example, achalasia of the esophagus is treated with a balloon pneumocardiodilation method. Injection of botulinum toxin into the esophageal sphincter muscles is used less frequently. If drug treatment does not produce results, the patient undergoes surgery - myotomy. In any case, the patient must comply special diet, especially with gastroesophageal reflux disease, esophagitis, Barrett's esophagus.

Asymptomatic hiatal hernias do not require urgent intervention; if they begin to block the lumen of the esophagus, then treatment consists of surgery. If a patient is diagnosed with a peptic ulcer of bacterial origin, treatment begins with eliminating the infection. If the underlying disease has caused complications in the form of gastric and esophageal bleeding or drug treatments do not have an effect, resection or photodynamic coagulation is performed.

With esophageal dysphagia, food should be taken 5-6 times a day in small portions. It is better to avoid dry and hard foods. Food should be chewed thoroughly; snacks should be a quick fix should be forgotten. It is not recommended to work bending over after eating. You need to have dinner at least 2 hours before bedtime. The diet of a person with dysphagia should include boiled vegetables, steamed lean meat or fish. You need to avoid spicy, fried and fatty foods, and smoked foods. It is forbidden to eat fast food and drink carbonated drinks, coffee and strong tea. Completely excluded alcoholic drinks. Fermented milk products and cereals are very healthy.