Have you ever felt like something is stuck in your throat or chest when you eat, drink a little water, or even swallow a pill? Do you feel like you can't swallow food as easily as you used to? Maybe you're unconsciously avoiding foods like coarse foods and meat. If you feel like this too, don't dismiss it as normal. Today we're going to talk about a medical condition that could be causing this. That is a narrowing of the esophagus, medically called Esophageal Stricture .
What is Esophageal Stricture?
Okay, let's understand this very simply. You know, we have a tube-like part that carries food from our mouth to our stomach (stomach). We call this the esophagus . It's like a water pipe. 'Stricture' means any tube, passage, or pipe in our body that becomes narrowed or blocked. So, Esophageal Stricture is when that tube becomes abnormally narrowed for some reason.
Imagine that dirt and rust build up inside a water pipe, gradually narrowing the pipe. The same thing happens to our esophagus. When it narrows, it reduces the space for food and drink to pass down easily. That's why we have difficulty swallowing.
This blockage can occur from inside the esophagus or from outside. The delicate lining of the esophagus (called the `mucosa`) can become inflamed or scarred and thickened. When this happens, the lining doesn't stretch when we swallow. Sometimes, something like a tumor in another organ around the esophagus can cause the esophagus to become blocked in this way, even if there is pressure from outside. Most of the time, this process happens very slowly, over time.
Is this situation serious?
Now you may be wondering if this is something dangerous. Actually, as doctors, we do not take this condition lightly. Because it directly affects your ability to swallow food, and if left untreated, it can get worse over time.
The best thing is that in most cases, this condition can be completely cured with simple, minor medical interventions. However, in a very small percentage, that is, very rarely, the cause of this blockage may be cancer. That is a serious condition. That is why we say that if you have difficulty swallowing, do not ignore it and see your doctor as soon as possible.
What are the symptoms of this? How do you feel?
The first and most common symptom is difficulty swallowing.. You may manage this by taking small bites of food in the beginning, chewing them well, and swallowing them. You may also be avoiding spicy, coarse foods (for example, fried rice, meats). But as your throat becomes more and more blocked, these things will no longer help. You may feel like there is a lump in your throat, or like your throat muscles are not working properly.
Imagine, a piece of chicken that you used to love to eat, now makes your throat feel tight. So you've cut back on eating chicken. You think it's because of "gastritis." But the real reason could be something else.
In addition to this main symptom, several other symptoms may appear.
| Symptom | Simply explained |
|---|---|
| Noncardiac chest pain | My chest hurts, but it's not because of a heart problem. It's because of a problem in my esophagus. |
| Coughing or choking when swallowing food | You may suddenly cough or choke when swallowing food. This may be because the food is not going down properly. |
| Regurgitation | Swallowed food comes back up into the throat. It's not like vomiting, it just feels like it's coming up. |
| Unintentional weight loss | Because you eat less, your body weight will start to decrease without you even realizing it. |
What are the main reasons for this?
There are several reasons why the esophagus can become narrow. Let's divide them into three main categories.
1. Chronic Esophagitis
This is the most common cause . It occurs when the inner wall of the esophagus is inflamed over a long period of time. Just as a wound on our skin leaves a scar as it heals, so too, when the esophagus is continuously injured, scar tissue (also known as fibrosis) forms. This scar tissue does not stretch like normal tissue, it thickens. This is why the esophagus narrows.
The main cause of this is chronic acid reflux . Many of us call this "gastritis." Simply put, it's when the acid in the stomach comes up and enters the esophagus. When this happens frequently, the acid burns and injures the delicate lining of the esophagus. Over time, these injuries become scars and block the esophagus. This is the cause of more than 75% of cases.
In addition, there are several other reasons:
- Pill Esophagitis: Some painkillers, especially NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen (paracetamol), can become lodged in the esophagus and damage its wall when used regularly, especially when swallowed with little water.
- Infectious Esophagitis: In people with weakened immune systems (such as HIV patients and cancer patients), some viruses (HPV, HSV-1) and fungi (Candida albicans) can cause inflammation of the esophagus.
- Eosinophilic Esophagitis: This is a rare condition caused by a problem with the immune system. The body overreacts to certain allergens, causing chronic inflammation of the esophagus. This can start in childhood.
2. Injury or Trauma to the esophagus
Scarring and blockages can also occur due to any injury to the inner wall of the esophagus. These can also occur as a side effect of accidents or medical treatments.
- Caustic Ingestion: Drinking a caustic liquid such as acid, either by mistake or with the intent to commit suicide, can cause severe burns and scarring of the esophagus.
- Thermal Injury: Swallowing something very hot (e.g. hot tea, hot porridge) suddenly can burn the esophagus.
- Cancer treatment:When receiving radiation therapy for cancer in the neck or chest area, inflammation of the esophagus (mucositis) and subsequent obstruction (RIES) can occur as a side effect.
- Medication: While the esophagus is dilated, injecting steroids into the blocked area can reduce inflammation and prevent reoccurrence.
- Endoscopic Stricturoplasty: In this, a special knife-like instrument is passed through the endoscope, which cuts the scar tissue that is causing the blockage in several places, widening the area.
- Stenting: A small, mesh-like tube (a `stent`) is placed in the blocked area to keep it open. This is like a stent for a blocked artery.
- Surgery: This is done very rarely. In cases of cancer and severe obstruction that does not respond to other treatments, surgery to remove the damaged part of the esophagus (`Esophagectomy`) may be necessary.
- If you feel any difficulty swallowing food.
- If you frequently experience heartburn or a feeling of acid coming up into your throat.
- If you lose weight for no apparent reason.
- If a piece of food gets completely stuck in the throat.
- If you are unable to swallow solid food at all.
- If food enters the trachea when swallowed and causes difficulty breathing.
- If you experience severe chest pain.
- Difficulty swallowing is not normal . It is a symptom. So don't ignore it.
- The main cause of heartburn is long-term gastritis or acid reflux . If you have frequent heartburn, get it treated.
- Early diagnosis and treatment of this condition can lead to a very good recovery. So if you have symptoms, don't be afraid to see a doctor.
- Many blockages can be cured with a simple procedure called dilation.
- If you experience sudden choking or severe chest pain, go to an Emergency Department (ETU) immediately.
Very important: If someone ingests such a toxic substance, immediately call the National Poisons Information Centre at the Colombo National Hospital . Also, take the patient to a hospital Emergency Treatment Unit (ETU) as soon as possible.
3. Cancer
This may sound scary, but it is important to know. Esophageal cancer can also cause this type of choking. However, unlike other causes, symptoms of choking due to cancer appear very quickly . If a person who has been eating well for a few weeks develops difficulty swallowing, it is especially important to be concerned. There are several types of esophageal cancer (Adenocarcinoma, Squamous cell carcinoma).
How is the diagnosis made?
If you have these symptoms, your doctor will likely refer you to a gastroenterologist. He or she will listen carefully to your symptoms and recommend several tests to confirm the condition.
| Test | What is happening? |
|---|---|
| Barium Swallow Test | This is an X-ray test. You are given a chalky white liquid called barium to drink. As you swallow it, a video X-ray is taken to see how the liquid moves down your esophagus. This can clearly see if there is any blockage or narrowing anywhere. |
| Upper Endoscopy / EGD Test | This is the most common and most accurate test to diagnose the disease. You are given a sedative, and a thin, flexible tube (an `endoscope`) with a small camera attached is inserted through your mouth to examine your esophagus, stomach, and the first part of your small intestine. This allows the doctor to see the inside of your esophagus on a screen. The location of the blockage, its cause, and the nature of the inflammation can be seen. If necessary, a small piece of tissue from a suspicious area can be taken and sent to a laboratory for examination (a `biopsy`). |
How is it treated?
The main goal of treating this is to widen the blocked esophagus again so that you can swallow food without any difficulty.
Main treatment: Esophageal Dilation
This is the most common treatment. Simply put, it involves gradually widening the blockage. Similar to an endoscopy, a special instrument (such as a scope or cylinder) is inserted into the esophagus to gradually widen the blockage. This is not done all at once, but several times a week. As the narrowing is gradually widened, your difficulty swallowing will gradually decrease. This treatment is very effective for simple blockages.
Other treatments
For some complex blockages, or in cases that do not respond to dilation treatment, other treatment methods may need to be used.
When should you see a doctor?
It is very important to be aware of these symptoms, because the sooner they are recognized, the easier it is to treat.
| When to seek medical advice | |
|---|---|
| Common situations when you should see a doctor: | |
| Go to a hospital's Emergency Treatment Unit (ETU) immediately! | |
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