Esophagus

The esophagus is the muscular tube that carries food and liquid from the throat to the stomach. Its conditions range from common functional problems such as reflux to tumours that need specialised surgical and oncological care. Careful investigation with endoscopy, imaging and, when needed, physiology studies guides the right treatment.

Gastro-esophageal reflux disease (GERD) and hiatal hernia

What it is: Reflux occurs when acid and stomach contents flow back into the esophagus. A sliding hiatal hernia, where the top of the stomach slips through the diaphragm, often contributes.

Symptoms: Heartburn, regurgitation, chest discomfort, chronic cough or hoarseness, and sometimes difficulty swallowing.

Treatment: Lifestyle measures and acid-suppressing medication in most cases. Laparoscopic fundoplication with hiatal hernia repair is considered for persistent symptoms, large hernias or when long-term medication is not desired.

Paraesophageal hernia

What it is: A type of hiatal hernia in which part of the stomach moves up into the chest alongside the esophagus. It can enlarge over time and, rarely, twist.

Symptoms: Chest or upper abdominal pain after eating, early fullness, vomiting, breathlessness or anaemia.

Treatment: Symptomatic hernias are usually repaired laparoscopically, returning the stomach to the abdomen and reinforcing the diaphragm.

Achalasia

What it is: A motility disorder in which the lower esophageal sphincter fails to relax and the esophagus loses its normal squeezing action.

Symptoms: Progressive difficulty swallowing both solids and liquids, regurgitation of undigested food, chest pain and weight loss.

Treatment: Laparoscopic Heller myotomy with partial fundoplication, endoscopic myotomy (POEM) or pneumatic balloon dilatation, chosen after manometry.

Barrett’s esophagus

What it is: A condition in which the lining of the lower esophagus changes after long-standing reflux. It carries a small increased risk of esophageal adenocarcinoma.

Symptoms: It has no specific symptoms of its own; patients usually have a history of reflux.

Treatment: Reflux control and regular endoscopic surveillance. Dysplasia or early cancer can often be treated endoscopically.

Esophageal diverticulum

What it is: A pouch that forms in the wall of the esophagus, most commonly just above the upper sphincter (Zenker’s diverticulum).

Symptoms: Difficulty swallowing, regurgitation of old food, bad breath, cough or aspiration.

Treatment: Small asymptomatic diverticula may be observed. Symptomatic ones are treated endoscopically or with surgical myotomy and diverticulectomy.

Benign esophageal tumours

What it is: Non-cancerous growths such as leiomyoma, the most common benign tumour of the esophagus arising from its muscle layer.

Symptoms: Often none. Larger lesions may cause difficulty swallowing or chest discomfort.

Treatment: Observation for small lesions, or surgical enucleation, often minimally invasive, for symptomatic or growing tumours.

Esophageal cancer

What it is: A malignant tumour of the esophagus, mainly adenocarcinoma or squamous cell carcinoma. Risk factors include reflux, Barrett’s esophagus, smoking and alcohol.

Symptoms: Progressive difficulty swallowing, weight loss, pain behind the breastbone, hoarseness or bleeding.

Treatment: Treatment depends on stage and general fitness and is planned by a multidisciplinary team: endoscopic treatment for very early disease, chemotherapy or chemoradiotherapy followed by esophagectomy for localised cancer, and systemic therapy or palliation for advanced disease.

Esophageal perforation

What it is: A tear through the full thickness of the esophageal wall, caused by forceful vomiting, a swallowed foreign body or as a complication of a procedure.

Symptoms: Sudden severe chest or neck pain, fever, difficulty breathing and rapid deterioration.

Treatment: A surgical emergency. Depending on timing and extent it is managed with endoscopic stenting or clipping, drainage, or surgical repair, together with antibiotics and nutritional support.

How assessment is organized

Assessment usually includes upper endoscopy with biopsies when needed, contrast studies or CT, and, for functional disorders, esophageal manometry and pH monitoring. For tumours, staging with CT, PET-CT and endoscopic ultrasound helps plan treatment, which is discussed within a multidisciplinary team.

This information is general and does not replace individual medical assessment.