Esophagram
Esophagram is a test whereby the patient is administered a barium sulfate compound that enables the radiologist to study the function and appearance of the esophagus. A series of x rays of the esophagus is taken after the patient has swallowed the barium. The barium solution coats and outlines the walls of the esophagus. This enables the radiologist to assess the process of swallowing. Hence it is also called barium swallow. An Esophagram is done when the patient complains of pain or difficulty in swallowing. It is also done to assess the reasons for blood stained vomit and when abdominal pain and weight loss occurs or diagnosing cases of Barrett's esophagus. The Esophagram helps the radiologist to detect narrowing, stricture, obstruction or irritation of the esophagus. It helps to study complications such as ulcers, polyps and tumors. It also helps to assess hiatal hernia.
The patient is advised not to eat or drink for 8 to 10 hours prior to the examination. The patient is asked not to smoke or chew gum atleast 6 hours prior to the procedure. A patient is given a cup of barium sulfate to swallow. A radiologist watches and evaluates the swallowing process with fluoroscopy. The barium swallowed coats the lining of the esophagus, and x rays are taken to track the pathway to the stomach. The patient is placed in various positions throughout the exam so that structures are optimally demonstrated on the x rays.
The problem is that it can miss small abnormalities in the esophagus such as small erosions and ulcers. This test is not very effective for diagnosing gastroesophageal reflux associated with GERD. Pregnant mothers are advised not to undergo this procedure as the risk of radiation affects the fetus.
Schatzki's Ring
Schatzki's Ring or esophagul ring refers to a smooth and narrow ring of tissue in the lower end of the esophagus. It narrows down and blocks the esophagus. This esophagul ring is noticed among nearly 6% of the population. Schatzki's Ring is usually associated with long term damage due to stomach acid reflux. It can also occur due to a congenital defect. Schatzki's Ring is often associated with a hiatal hernia. Some chunks of food may get caught in the ring and lead to dysphagia (difficulty in swallowing large pieces of food). The degree of difficulty in swallowing depends on the extent of narrowing of the esophagus.It also results in chest pain under the sternum. But very often persons suffering from Schatzki's Ring are unaware of it.
A gastroenterologist can help in treating Schatzki's Ring. An EGD (esophagogastroduodenoscopy) or barium swallow aid in diagnosing this condition. Endoscopic examination of the esophagus also helps in diagnosing Schatzki's Ring. Drinking plenty of fluids and eating soft food can help tackle this. Surgical dilation of esophagul ring with a mercury -filled dilator (bougie) can offer relief. Dilators are passed into the mucosal ring to ease the symptoms. The lower esophagul ring tissue can be surgically removed too.
Esophagitis
Esophagitis is a condition where there is inflammation and swelling of the esophagus. Esophagitis is caused by stomach acid reflux, fungal or viral infection of the esophagus, certain medications and weakened immune system. If esophagitis is left untreated, it can lead to ulcers and difficulty in swallowing. This can lead to scarring of the esophagus and a situation where food may stick in the area (dysphagia). Often Hiatus Hernia causes Esophagitis since the distension of the stomach through the diaphragm muscle hampers the draining of food and stomach acid. This results in the damage of the esophagal tissue. Candida yeast infection can develop in the esophagus and lead to esophagitis. It attacks when the immune system is weakened and is treated with anti-fungal drugs.
A person suffering from esophagitis has difficulty in swallowing and nausea and vomiting. There are mouth sores. Heartburn involves acid reflux into the esophagus as a burning sensation with a bitter-tasting liquid that may regurgitate into the mouth. A patient can reduce the symptoms of esophagitis by eating smaller meals and avoiding eating for 2 hours before going to bed. Avoid too much spices and acidic food and beverages. Take small bites and chew food thoroughly before swallowing. Place your head at an elevation while sleeping to prevent regurgitation and stomach acid reflux. Smoking, alcohol, caffeine, chocolate, peppermint and fatty foods can aggravate the condition.
The physician can view the esophagus with an endoscope to look for scarring and inflammation. A biopsy can be taken for diagnosis. A Barium swallow involves use of a special dye to facilitate x-ray of the esophagus and check for abnormalities. Antacids can help in reducing stomach acid reflux. Medication to improve the strength of the LES muscle can help in treating esophagitis. Antibiotics or anti-fungal drugs may be prescribed to treat the infection. Inflammation can be reduced with the help of corticosteroid medication. Surgery is resorted to in cases where there is a hiatus hernia or to remove the damaged part of the esophagus.
Bibliography / Reference
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