While gastroenterologists primarily focus on the digestive tract, including the esophagus, otolaryngologists (ENTs) also assess and manage conditions affecting the upper esophagus. Their involvement stems from the close anatomical and functional relationship between the throat, voice box, and the beginning of the swallowing tube.
The ENT’s Role in Esophageal Health
An ENT’s involvement in esophageal health is rooted in the connection between the upper aerodigestive tract and swallowing. The throat (pharynx) and voice box (larynx) are directly above the esophagus, so issues originating in the esophagus can manifest with symptoms in these upper regions.
ENTs possess specialized knowledge of the pharynx, larynx, and the upper esophageal sphincter, the muscular valve at the top of the esophagus. They identify how esophageal issues like reflux can irritate or damage throat and vocal cord tissues. This expertise allows them to diagnose and manage conditions with throat or voice symptoms, even if the root cause lies lower in the swallowing pathway.
Common Esophageal Conditions Managed by ENTs
ENTs diagnose and manage several esophageal conditions, especially those affecting the upper swallowing tube or presenting with throat and voice symptoms. Laryngopharyngeal reflux (LPR) is common, where stomach acid irritates the pharynx and larynx, causing hoarseness, chronic cough, or a lump sensation. Unlike gastroesophageal reflux disease (GERD), LPR often occurs without classic heartburn.
Esophageal spasms, particularly in the upper segment, also fall under an ENT’s purview. These involuntary muscle contractions can cause difficulty swallowing or chest discomfort. Zenker’s diverticulum, a pouch above the esophagus, can trap food, causing regurgitation, bad breath, and swallowing difficulties. ENTs often diagnose and surgically treat this condition.
Globus sensation, a feeling of a lump in the throat, is another common complaint ENTs address. It can be linked to esophageal dysfunction or irritation. Dysphagia, or swallowing difficulties, arising from upper esophageal or related pharyngeal/laryngeal issues, are frequently managed by ENTs.
Diagnostic Methods Used by ENTs
ENTs employ specific procedures to evaluate the esophagus and related structures, often focusing on the upper region and the impact of esophageal issues on the throat and voice. Laryngoscopy and pharyngoscopy are common visual examinations where a thin, flexible scope views the larynx and pharynx. These procedures can reveal signs of esophageal reflux, such as redness, swelling, or irritation of the vocal cords and surrounding tissues.
Flexible Endoscopic Evaluation of Swallowing (FEES) is another valuable tool where a small scope is passed through the nose into the throat to directly observe the swallowing process. This allows the ENT to assess how food and liquids are handled and if there is any aspiration or difficulty with passage into the upper esophagus. For direct visualization of the upper esophagus, an ENT may perform a limited esophagoscopy to examine a specific area, remove a foreign body, or obtain a biopsy.
ENTs also utilize or interpret barium swallow studies, which are X-ray procedures where the patient swallows a liquid containing barium. This allows observation of esophageal movement to identify any structural abnormalities, narrowing, or motility issues.
When to See a Gastroenterologist
While ENTs manage many upper esophageal and reflux-related issues, a gastroenterologist is the primary specialist for other esophageal concerns. Gastroenterologists are experts in the entire digestive system, including the esophagus, stomach, and intestines. Patients with symptoms predominantly affecting the lower esophagus or stomach, such as severe, persistent heartburn, significant regurgitation, or abdominal pain, typically require a gastroenterologist’s evaluation.
Conditions necessitating a gastroenterologist’s expertise include chronic, severe gastroesophageal reflux disease (GERD) that may have led to complications like Barrett’s esophagus or peptic strictures. They also manage esophageal ulcers, eosinophilic esophagitis, or complex motility disorders affecting the entire esophagus. They perform comprehensive procedures like full esophagogastroduodenoscopy (EGD) to visualize the entire esophagus, stomach, and duodenum, and advanced motility studies such as high-resolution manometry.
If initial treatments from an ENT for upper esophageal or reflux-related symptoms are not effective, a referral to a gastroenterologist is often necessary to explore other causes or more advanced management options. The collaboration between ENTs and gastroenterologists ensures that patients receive thorough and appropriate care for their specific esophageal condition.