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Disorders of the Esophagus & Stomach

By Ruth Coleman

The esophagus primarily serves to pass food to your stomach, which breaks down the food. To do so, the stomach secretes acid, produces a lubricant to protect itself from the acid, kills bacteria, starts the process of digesting proteins and secretes a substance that is needed for you to absorb vitamin B12. Yet, the esophagus and stomach are susceptible to several disorders.

Achalasia

Achalasia is a disorder of the esophagus. There is a lower esophageal sphincter, which is a muscle, where the esophagus meets the stomach. In achalasia, that sphincter does not relax enough, there are fewer nerves than normal and there is no peristalsis in the lower two-thirds of the esophagus. (Peristalsis is the contraction and relaxation movement of the esophagus that pushes the food along.) As a result, food and drink do not pass from the esophagus to the stomach as they should. Most people will gradually have problems eating and drinking. Because the sphincter does not relax, the shape of the esophagus is deformed and on an X-ray looks like a bird’s beak.

Boerhaave’s Syndrome

This is a perforation, or rupture, that involves all of the layers of the esophagus. According to Moss Mendelson, M.D., Associate Professor at the Eastern Virginia School of Medicine in “Tintinalli’s Emergency Medicine,” it is because of a sudden increase of pressure within the esophagus. Boerhaave’s syndrome happens most of the time because of excessive, strong vomiting, usually after a large consumption of alcohol.

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Gastroesophageal Reflux Disease (GERD)

The lower esophageal sphincter causes GERD when it is too relaxed, because it does not prevent the stomach contents from refluxing back into the esophagus. Michael DiMarino, M.D., clinical assistant professor of medicine at Thomas Jefferson University, writes in “The Merck Manual for Healthcare Professionals,” that caffeine, cigarettes, fatty foods, alcohol, soda and obesity can all contribute to GERD. The symptoms may include heartburn, laryngitis, difficulty swallowing and coughing.

Hiatal Hernia

A hiatal hernia is a disorder in which part of the stomach herniates through an opening in the diaphragm and goes into the chest. (The diaphragm is a muscle that separates the abdomen from the chest. It has openings to allow certain structures to pass.) There are two types of hiatal hernias: a sliding hiatal hernia and a paraesophageal hiatal hernia. In the sliding type, the gastroesophageal junction (where the esophagus meets the stomach) goes into the chest along with part of the stomach. In the paraesophageal type, the gastroesophageal junction stays below the diaphragm where it belongs, but part of the stomach goes up into the chest. People with a sliding hiatal hernia may also have GERD.

Zollinger-Ellison Syndrome

Kenneth McQuaid, M.D., professor of clinical medicine at the University of California San Francisco, explains in “Current Medical Diagnosis & Treatment” that this disorder is caused by a tumor that secretes gastrin, a hormone that stimulates the release of hydrochloric acid by the stomach. The tumor's release of gastrin is uncontrolled. This leads to high levels of hydrochloric acid, which causes a peptic ulcer. The tumor itself is usually in the small intestines or the pancreas.

Erosive Gastritis

Erosive gastritis is the inflammation of the stomach. According to Sidney Cohen, M.D., professor of medicine at the Thomas Jefferson University Hospital, in “The Merck Manual for Healthcare Professionals,” it is usually caused by stress, alcohol and non-steroidal anti-inflammatory drugs (NSAIDs). Most of the time, there are no symptoms. When people have symptoms, they may include pain and a minor amount of bloody vomiting.

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