Diagnosis & Treatment of Esophageal Conditions

Esophageal disorders can affect your ability to eat, sleep and enjoy life. Symptoms may include acid reflux, regurgitation of undigested food, difficulty swallowing, persistent heartburn and upper abdominal pain. Tell your doctor if you have prolonged indigestion that has not improved with medication. A gastroenterologist can determine the cause of your symptoms and help you find treatment for esophageal disorders.

Diagnosing esophageal conditions

After completing a physical exam and reviewing your medical history, your gastroenterologist may order the following tests to determine the cause of your symptoms:

  • Blood tests may be taken to assess mineral and vitamin levels, anemia and albumin levels.
  • Stool tests, such as a fecal occult blood test, may be taken to identify if there is blood in the stool.
  • Food allergy testing can identify an allergy to specific food types.
  • Imaging tests including an abdominal computed tomography (CT), chest X-ray, diagnostic laparoscopy, magnetic resonance imaging (MRI), PET scan or ultrasound may be completed to identify problems in the esophagus.
  • Barium swallow or upper gastrointestinal (GI) series uses a barium solution that you drink to coat the inside of your digestive tract. This allows your doctor to see a silhouette of your esophagus, stomach and upper intestine on X-rays.
  • Upper GI endoscopy is used to view the esophagus and check for inflammation or other symptoms. A small tube with a camera is inserted through your mouth and throat to examine the inside of your esophagus and stomach. The same tube can be used to remove a small piece of tissue to be examined under a microscope.
  • Esophageal manometry is a test that measures the rhythmic muscle contractions, coordination and force in your esophagus when you swallow.
  • Esophageal pH monitoring is a 24-hour-pH test that measures when and for how long stomach acid flows up into the lower esophagus. After your throat is sprayed with a mild anesthetic, a thin tube is put into your nose or mouth and down the esophagus. The tube is attached to a monitor that you wear around your waist (or in your pocket) to record the level of acid activity. You’ll also keep a diary of your symptoms.

Internationally recognized esophageal cancer care

With state-of-the-art diagnosis and treatment, there is no better place for esophageal cancer care than Virginia Mason Franciscan Health. Our high volumes and survival outcomes that exceed national and international averages speak to the experience and expertise of our team. The Thoracic Oncology Tumor Board—a group of experts from thoracic surgery, medical oncology, radiation oncology, gastroenterology, radiology and pathology—reviews individual cases. 

Our specialists work together to provide the highest quality, integrated care for esophageal cancer and gastric cancer. Treatment may include surgery, chemotherapy, radiation and targeted therapies using antibodies to target specific molecules within cancer cells.

Cancer Service Line Video – Dr. Donald Low:

Treating esophageal conditions

Once the cause of your symptoms has been determined, your gastroenterologist can determine the best treatment options for you, which may include:

Diet and lifestyle changes

Your doctor may recommend making changes to your diet or lifestyle to manage symptoms, such as:

  • Avoid certain foods and drinks: Your provider may recommend that you avoid common heartburn triggers, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion and caffeine. Your provider may recommend skipping certain foods, such as dairy or wheat products, to relieve symptoms and reduce inflammation.
  • Elevate the head of your bed: If you regularly experience heartburn while sleeping, your provider may recommend elevating the head of your bed 6 to 9 inches.
  • Maintain a healthy weight: Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. Weight loss may help relieve symptoms.
  • Relaxation therapies: Techniques to calm stress and anxiety may reduce signs and symptoms of heartburn or acid reflux.

Medications

Medications for esophageal conditions may include antibiotics to treat infection, anti-inflammatory medications, corticosteroids and promotility agents, a type of medication that promotes movement through the GI tract. 

  • H2 receptor blockers are over-the-counter antacids used to treat heartburn and acid reflux.
  • Proton pump inhibitors block acid for longer periods of time and can protect the esophagus from acid while inflammation heals.
  • Promotility agents work to stimulate muscles in the GI tract so acid doesn’t stay in the stomach too long.
  • Topical steroids are spray steroids that may reduce inflammation in the esophagus. Steroids have fewer side effects compared to proton pump inhibitors.

Treatments and procedures

If surgery is needed, your gastroenterologist and surgeon will discuss your options and recommend minimally invasive and robotic-assisted procedures whenever possible: 

  • Endoscopic ablation therapy is a minimally invasive procedure that removes diseased cells in the mucosal layer of the esophagus. The removal is achieved by using an endoscope and a treatment modality such as cryotherapy, photodynamic therapy or radiofrequency ablation.
  • Dilation therapy is an endoscopic procedure with a dilating tube that is passed into the esophagus to widen a ring or stricture.
  • A gastric stimulator stimulates and regulates the electrical activity in the nerves and muscles of the stomach, allowing the muscles to contract and digest food, and reduces nausea, vomiting and sometimes pain. Implanting the device, about the size of a small pager, is done as a minimally invasive procedure.
  • Esophageal surgery may be recommended to repair functional problems of the esophagus or remove cancerous or diseased tissue. Surgery may involve removing a portion of the esophagus and connecting the remaining esophagus to the stomach.

Esophageal disorders we treat

  • Barrett's esophagus

    Barrett’s esophagus is a disorder of the lining of the lower esophagus caused by persistent gastroesophageal reflux disease or GERD. GERD is the backward flow of stomach acid into the esophagus, which causes a sour taste and a burning sensation in the throat. Screening and prevention are important aspects of care because individuals with Barrett's are at a significantly higher risk of developing esophageal cancer. Learn more

  • Esophageal cancer

    Surgery, radiation and chemotherapy are all options in the treatment of thoracic/esophageal cancer. A multidisciplinary team of specialists create a plan of care unique to each person and his or her particular form of cancer. This treatment plan is consistently evaluated and adjusted as needed. Learn more

  • Eosinophilic esophagitis (EoE)

    Eosinophilic esophagitis, also known as EE or EoE, is an allergic, inflammatory condition where the wall of the esophagus becomes filled with eosinophils, a type of white blood cell. This buildup is often a reaction to foods, allergens or acid reflux, and can injure esophageal tissue, leading to difficulty swallowing. Learn more

  • Gastric cancer

    Gastric cancer, also known as stomach cancer, begins when mucus-producing cells in the inner lining of the stomach begin to divide without stopping. These cells can grow slowly into a tumor over the course of many years. Many symptoms of gastric cancer are easily ignored since they cause only modest discomfort. That is why gastric cancer often advances before being detected. Learn more

  • Gastroesophageal reflux disease (GERD)

    GERD is a common disorder affecting more than 17 million adults and children. It occurs when stomach contents and acid flush back up into the esophagus causing irritation and inflammation in the esophageal lining. Learn more

  • Gastroparesis

    Gastroparesis is a medical term for delayed emptying of stomach contents. The condition is common among people with type 1 and type 2 diabetes, and may be caused by damage to the vagus nerve that extends from the brain to the stomach. Learn more

  • Hiatal hernias

    When an internal body part pushes into another area of the body, it’s called a hernia. Hiatal hernias commonly occur when the upper stomach moves from the abdominal cavity through the diaphragm, over the lower part of the esophagus, and up into the chest cavity. Learn more

  • Peptic ulcers

    A peptic ulcer is a variably painful open sore that forms when acid erodes the inner lining of the digestive system. When a peptic ulcer occurs in the stomach, it’s called a gastric ulcer. When it’s located in the upper part of the small intestine, it’s called a duodenal ulcer. Learn more

  • Short bowel syndrome

    The small intestine is the organ that absorbs nutrients from food such as fats, carbohydrates and vitamins during digestion. Short bowel syndrome means that part or all of the small intestine is missing or has been surgically bypassed, leading to the body being unable to process all of the dietary nutrients it needs to function properly. Learn more

  • Swallowing and motility disorders

    Swallowing disorders can occur for any number of reasons, including conditions affecting the esophagus such as cancer, strictures, rings or gastroesophageal reflux disease (GERD), or from other problems such as stroke, diabetes and scleroderma. Motility is the movement of food and liquid by the esophagus muscles down the esophagus and into the stomach. Learn more

Find a gastroenterologist near you

If you have symptoms of an esophageal disorder, such as acid reflux or difficulty swallowing, our gastroenterologists can help.