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.

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.

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.

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

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 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.

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.

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