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Esophageal Pain

Esophageal Pain

Pain felt in the esophagus is often difficult to diagnose, as it may mimic chest pain that occurs due to cardiac problems. The current article presents an overview on the possible causes of such pain, as well as the accompanying symptoms and treatment options.
Dr. Sumaiya Khan
Last Updated: Feb 14, 2018
The esophagus or food pipe is a muscular tube responsible for passage of food bolus from the pharynx to the stomach by peristalsis. Several conditions affect the structural and functional integrity of this organ, leading to esophageal pain and irritation.

Acid reflux is the most common reason behind pain in the esophagus, followed by inflammation and ulceration of the esophagus. Alterations in espohageal motility, autoimmune responses as well as cancer are some of the other factors that may lead to esophageal chest pain.

The etiology behind pain in the esophagus, as well as the common symptoms and treatment methods have been described below.

Causes for Esophageal Pain

Acid Reflux Disease
Acid reflux and gastroesophageal reflux disease (GERD) is characterized by repeated regurgitation of food from the stomach into the esophagus. Such backward flow of gastric contents lead to irritation and pain in the esophagus, since it is not equipped to deal with acidic conditions. Chronic acid reflux disease may alter cellular composition at the lower end of the esophagus, leading to Barrett's esophagus. Nicotine, caffeine, alcohol, spices, high-fat food items and certain medications, especially antibiotics, may further aggravate the condition.

Inflammation and swelling of the esophagus is termed as esophagitis. It may be the result of acid reflux, excessive consumption of alcohol and tobacco, vomiting, bacteria like Helicobacter pylori, viral infections like herpes, fungal infections like candidiasis, as well as certain medications. In addition, weak immune system may increase the susceptibility to esophageal infections. Autoimmune disorders like eosinophilic esophagitis also involve esophageal inflammation and pain. In severe cases, it may lead to scarring of the tissue.

Esophageal Spasm
This condition refers to the abnormal contractions of esophageal muscles, which alters peristaltic movements through the esophagus. The etiology behind such spasms is not yet completely understood. However, acid reflux as well as hot and cold beverages have been observed to trigger episodes of abnormal spasms. They may occur suddenly, and manifest as severe chest pain.

Sphincter Irregularities
Sphincters are small muscular rings that control the entry and exit of substances through orifices by timely relaxation and contraction. Two such sphincters are present at the upper and lower ends of the esophagus, and are called upper and lower esophageal sphincters respectively. Any malfunction in these two sphincters affects passage of food through the esophagus, and may lead to pain, vomiting, and infections if the food bolus stays in the food pipe for long time.

Such sphincter irregularities may arise due to neuromuscular problems or structural alterations. Esophageal achalasia is an example of such irregularity, and involves incomplete relaxation of the lower esophageal sphincter. As a result food bolus remains in the food pipe, and may even be inhaled into the lungs leading to pulmonary aspiration.

Esophageal Ulcers
Peptic ulcers or sores present in the esophagus are termed esophageal ulcers. These can arise due to damage of the esophageal mucosa by acidic contents, bacteria and medications. Such ulceration causes pain, especially when food bolus passes through the esophagus. If untreated, these ulcers may bleed and cause further tissue damage.

Esophageal Varices
The enlargement of veins located near the lower end of the esophagus is termed esophageal varices. These veins may even rupture, leading to bleeding and severe pain. Liver cirrhosis and portal hypertension are the most common reasons behind this condition.

Esophageal Cancer
Cancerous growths in the esophagus may arise due to chronic GERD, excessive intake of spices, tobacco and alcohol. It is often characterized by esophageal pain, difficulty in swallowing, unintentional weight loss, fatigue and general malaise. Squamous cell carcinoma and adenocarcinoma are two major types of cancers that originate in the esophagus.

Other Cause
  • Physical or chemical injury and tears in the esophageal wall
  • Tissue damage because of excessive exposure to radiation
  • Esophageal hypersensitivity
  • Esophageal webs and Plummer-Vinson syndrome (PVS)
  • Autoimmune disorders like systemic scleroderma
Accompanying Symptoms
  • Chest pain
  • Abdominal pain
  • Difficulty while swallowing
  • Belching
  • Bloating
  • Bad breath
  • Flatulence
  • Diarrhea
  • Constipation
Severe conditions may involve:
  • Choking
  • Aspiration
  • Respiratory distress
  • Wheezing
  • Vomiting blood
  • Black, tarry stools
  • Fever
  • Fatigue
  • Shoulder and arm pain
Diagnosis and Treatment
Precise etiology behind the pain can be identified using imaging studies like endoscopy and barium swallow (esophagography), as well as blood and tissue investigations. Treatment options depend on the causative factor, and mostly include:
  • Medicines like anti-histamines and proton pump inhibitors which reduce acid production in the stomach
  • Esophageal dilation in case of abnormal constriction of esophagus
  • Surgical removal of damaged and/or cancerous parts of the esophagus

Tips to Relieve Esophageal Pain
  • It is advisable to follow a diet low in spices and foodstuffs that may irritate the esophageal lining.
  • The foods that trigger acid reflux may vary with each individual. Hence, it is imperative to identify and prepare your own list of foods to be avoided.
  • The consumption of acidic foods may further aggravate pain, and hence should be avoided by people with esophageal injuries and ulcers.
  • Stress, alcohol and tobacco have been identified as the contributing factors for esophageal problems. Hence, it is advisable to indulge in stress management techniques and exercises, as well as refrain from smoking and alcohol consumption.
  • Consumption of very hot foods or beverages must be avoided, since it may increase the burning sensation and pain.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for professional medical advice.
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