Definition Oesophageal obstruction is a blockage or narrowing of the oesophagus, the muscular tube that carries food from the mouth to the stomach. This condition usually causes problems with swallowing.
What is going on in the body? Oesophageal obstruction occurs when an abnormality, injury, or disease narrows the oesophagus. Once the tube narrows, swallowing becomes difficult. If the oesophagus gets completely blocked, swallowing cannot occur. At that point, vomiting occurs and sometimes stomach content leaks into the lungs. This can cause a serious problem called aspiration pneumonia.
What are the signs and symptoms of the condition? The symptoms of a narrowed oesophagus include:
difficulty swallowing
pain with swallowing
regurgitation of food
weight loss
What are the causes and risks of the condition? Oesophageal obstruction can occur for a variety of reasons, including:
abnormal structures. A person may be born with an abnormal oesophagus, such as oesophageal atresia. It may have extra tissue, called oesophageal webs, crossing through it. There may also be a ring of thick muscle around the oesophagus, called Schatzki's ring.
injury. Children who swallow lime products, such as drain cleaners, can develop oesophageal stricture, or narrowing. A person may also be injured during an endoscopy, the examination of the oesophagus and stomach with a lighted tube.
prolonged use of a nasogastric, or stomach, tube which can cause oesophageal stricture
infection by certain viruses and bacteria, which can cause narrowing of the oesophagus
other diseases, such as gastro-oesophageal reflux disease. In this condition, stomach acids come up into the oesophagus and cause damage.
oesophageal cancer, which can cause narrowing or blockage
What can be done to prevent the condition? Chemical injury can be prevented by storing dangerous chemicals in a safe place. Other injury can be prevented by careful medical procedures. Nasogastric tubes should be used only as long as necessary. Acid damage to the oesophagus can be prevented by treating gastro-oesophageal reflux disease.
How is the condition diagnosed? A history of swallowing problems gives a clue to the diagnosis. Narrowing or blockage is diagnosed by x-rays taken after the person has swallowed a thick dye. This is called an upper GI series, or barium swallow. The reason for the narrowing can be found by endoscopy.
What are the long-term effects of the condition? Depending on the cause, narrowing can progress to total blockage. Narrowing that is not relieved can lead to poor malnutrition and weight loss. Total blockage can cause regurgitation of food and liquid into the lung. There, these materials can cause inflammation and breathing problems, known as aspiration pneumonia. oesophageal cancer can spread and lead to death.
What are the risks to others? There is no risk to others.
What are the treatments for the condition? Narrowing caused by abnormal structures or injury may be relieved by dilation. In this procedure, instruments of increasing size are inserted through the narrowed area. This gradually opens the oesophagus. The procedure may have to be repeated to relieve the symptoms. Dilation may also have to be repeated if the narrowing returns. Sometimes a stent, or firm tube, is placed across the narrow area to keep it open.
When dilation does not fix the problem, surgery may be necessary. Sometimes just the narrowed portion can be removed. Other times, the oesophagus is replaced with a piece of the stomach or large intestines.
A person with oesophageal cancer sometimes get better with radiation therapy or chemotherapy.
What are the side effects of the treatments? Dilation of the oesophagus may not work or may have to be repeated. Any surgery can cause bleeding, pain, or infection.
What happens after treatment for the condition? Sometimes the narrowing returns. In that case, dilation may have to be repeated. If dilation does not work, surgery may be needed.
How is the condition monitored? Dilation is repeated if symptoms worsen. If symptoms cannot be controlled by dilation, surgery may be needed.
Author: William M. Boggs, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
