The esophagus (esophagus) is an organ in the form of a tube that extends from the pharynx to the stomach. It is responsible for the transport of oral foods and beverages from the mouth to the stomach. It is approximately 25 cm long. There are specialized muscles along the esophagus that prevent food from escaping when not eaten, and these are called the sphincter. Gastroesophageal reflux may develop in lower sphincter insufficiency. There are two common symptoms in esophageal diseases: dysphagia (difficulty swallowing) and back / chest pain.

 

Esophageal Cancer
 
The incidence of esophageal cancer varies widely around the world. There are 2 types of esophageal cancer. One of these is squamous cell cancer arising from the inner wall of the esophagus. It is generally seen in the middle and upper esophagus. The other is adenocarcinoma and often develops from the junction of the esophagus with the stomach, the lower end, due to chronic reflux.
 
 
Risk factors
 
Advanced age: the incidence of esophageal cancer increases after the age of 60
• Male gender: the incidence of esophageal cancer in men is 3 times higher.
• Social / Economic / Ethnic distribution: Squamous cell carcinomas are more common in smokers and alcohol users, regions where excessively hot food consumption is common, Asians and African Americans, while adenocarcinomas are associated with obesity and reflux and are more common in the Caucasian race.
Smoking
Alcohol intake
Barrett esophagus: Barrett esophagus; It is the change in the cell type of the lower esophagus due to acid reflux from the stomach chronically.
Human Papilloma Virus (HPV)
• Exposure to chemicals: such as ingestion of caustic substances
Achalasia, Tylosis, Plummer Vinson
 
 
Symptoms
 
Esophageal cancer is a disease that may be delayed for diagnosis due to late symptoms and signs. Therefore, when diagnosed, cancer may be at an advanced stage. The first symptom is usually difficulty swallowing. With tumor growth, swallowing food or drink becomes difficult and can be painful. Other symptoms of esophageal cancer are; Pain in the chest or back, weight loss, bleeding, dark color in defecation, cough, hoarseness.
 
 
Treatment
 
Like all cancers, esophageal cancer should be staged after diagnosis. Staging is done by looking at the conditions such as spreading of the surrounding tissue, lymph node spattering or splashing to distant organs (metastasis). And treatment is given according to the stage of the disease. Surgery can be performed minimally invasively (closed method) or open method. The most common method currently used is the minimally invasive method using laparoscopy and thoracoscopy. Surgically, the cancerous part of the esophagus is removed. After the removal process, a part of the stomach or large intestine is pulled up to the chest, ensuring the continuity of the digestive system. Pre-operative chemotherapy and sometimes with radiotherapy can be applied to reduce advanced esophageal cancers and make them suitable for surgery. In addition, by looking at the pathological examination report of the tumor removed after the operation, chemotherapy can be given to the patients systemically.
 
 
Esophageal Cancer Prevention
 
There is no specific method for general prevention from esophageal cancer. However, protection can be provided by eliminating risk factors.
 
Achalasia
 
Achalasia disease is a rare movement disorder of the esophagus. Although the cause is not known exactly, it manifests itself with difficulty in swallowing. Difficulty swallowing first liquid and then solid foods occur. It is characterized by movement disorder in the esophageal smooth muscle and relaxation disorder in the lower esophageal sphincter.
 
Symptoms
 
• Difficulty swallowing: this is the most common and earliest symptom. Patients cannot swallow both solids and liquids.
• Food coming into the mouth
Weight loss
A burning sensation or pain in the chest
Cough after meals
 
Diagnosis
 
Following tests can be performed to support the diagnosis of achalasia after the patient's symptoms and physical examination;
1. Endoscopy: It is the direct examination of the esophagus and the valve opening to your abdomen with the help of a flexible device with a camera.
2. Esophagogram (Barium esophagus radiography): It is the visualization of the movements of the esophagus while swallowing a contrast agent called barium.
3. Manometric examination: it is a simple pressure measuring tube. It helps to measure the amount of pressure the esophagus exerts on liquid or solid foods. Manometry is sent to the esophagus and from there to the stomach. This test can show the increase in pressure in the contractions of the muscles involved.
 
 
Treatment
 
Purpose in treatment; It is the elimination of symptoms by correcting the stenosis in the passage from the esophagus to the stomach and providing normal nutrition.
1. Drug therapy: It is used for the purpose of correcting nutrition in patients where other treatment methods cannot be applied and while preparing for the actual treatment. Calcium channel blockers and nitrate group drugs benefit from their relaxing effects on smooth muscles.
2. Botulinum Toxin Injection: Botox is a drug that prevents muscle contraction. Botox can be injected into the muscles in this valve to relax the valve opening where the esophagus and stomach join. This procedure is done by endoscopy. The effect of botox usually passes between 3 months and a year, so the procedure may need to be repeated when the drug loses its effect.
3. Pneumatic Dilation: A balloon is sent into the esophagus through endoscopy, passed through the valve between the esophagus and stomach, and then inflated.
4. POEM: It is the process of cutting the problematic muscles of the esophagus with a tunnel created endoscopically by entering through the mouth.
5. Surgical Treatment: With closed surgery (laparoscopic), the smooth muscle tissue that covers the lower end of the esophagus and causes difficulty in swallowing is cut and separated. While this procedure provides treatment at a rate of up to 95%, it is superior to all endoscopic procedures by allowing simultaneous fundoplication (gastroesophageal reflux surgery) to prevent reflux due to gastric acid that may develop afterwards.
 
 
Esophageal Benign Tumors
 
Esophageal benign tumors and cysts are extremely rare. Although they are benign, if they narrow the esophagus, they can also cause pneumonia as a result of swallowing difficulty, bleeding, painful swallowing or food residues entering the lung tract. Although there are many types of benign esophageal tumors, Leiomyomas are the most common. It is more common in young and middle-aged men. They appear as a single, well-circumscribed mass in the middle and lower third of the esophagus. They grow slowly, usually do not cause symptoms, and are detected incidentally. The most common symptoms are difficulty in swallowing, burning or pain in the back of the chest as in other esophageal disorders. Endoscopy, endoscopic ultrasonography (EUS) or computed tomography (CT) can be used for diagnosis. The treatment is surgical removal. Operation can be performed by thoracoscopic (closed) or open method.
 
 
Other Diseases of the Esophagus
 
Barrett Esophagus
 
Barrett esophagus is chronically formed when the acid in the stomach escapes towards the esophagus and the cell type where the esophagus meets the stomach changes. It is diagnosed by examining it endoscopically. Barrett's esophagus symptoms are also common with other esophageal diseases, including burning behind the chest, vomiting, bleeding with vomiting, difficult swallowing of solid foods, bitter taste in the mouth at night. Barrett esophagus is a complication of gastroesophageal reflux and its treatments are similar. The risk of Barrett's esophagus is that it may develop esophageal cancer. Therefore, medical treatments for gastroesophageal reflux can be applied, and surgery can be performed in patients who do not respond to medical treatment. If dysplasia / neoplasia is seen in the biopsy taken at the time of diagnosis (cancer-prone cells), surgery can be performed. Surgery can be done open or laparoscopically (closed).
 
 
Esophageal Diverticula
 
Esophageal diverticula; It is the name given to the outward pocketing of a layer or the entire esophagus. If these pockets occur in the upper esophagus, it is called Zenker diverticulum. Zenker diverticulum can occur in cases of esophageal contraction (motility) problems. Symptoms of Zenker diverticulum may include difficulty in swallowing, rumbling in the throat, regurgitation (what you eat and drink into the mouth) or a foul odor in the mouth due to food waiting in the pocketed tissue. For diagnosis, esophageal radiography with barium, endoscopy, tomography, neck ultrasonography and esophageal manometry can be used. Small or asymptomatic Zenker diverticulae can be followed up. The treatment of older or symptomatic ones is surgical. It can be applied by surgical endoscopic method or open method.
One of the other diverticula is traction diverticula and they are located in the middle of the esophagus, they usually do not cause symptoms and do not need treatment.
Epiphrenic diverticulum is a pocketing in the esophagus located just above the diaphragm and is usually caused by an esophageal motility disorder like achalasia. Therefore, surgical treatment is directed towards diverticula and achalasia and can be performed by open or laparoscopic (closed) method.