Pectus excavatum (PE) is the most common congenital deformity of the chest wall, characterized by an inward depression of the breastbone. While often associated with cardiac and respiratory issues, this condition can also exert pressure on the internal organs of the abdomen and mediastinum. This structural issue may lead to problems affecting the stomach and digestive system. This article investigates the anatomical link between the sunken chest and gastrointestinal symptoms.
Defining the Chest Wall Deformity
Pectus excavatum, also known as funnel chest, involves an abnormal structural development where the sternum and costal cartilages curve inward toward the spine. This creates a caved-in appearance that varies widely in severity. The deformity typically affects the lower end of the sternum and the attached ribs.
The condition is considered a skeletal issue, resulting in a significantly reduced anterior-posterior diameter of the chest cavity. Although present at birth, the indentation often becomes much more pronounced during the rapid growth spurts of adolescence. This progression means the physical impacts on internal organs can worsen over time.
How Compression Affects Internal Organs
The primary mechanism linking the chest deformity to digestive issues is compression within the body cavity. The depressed sternum pushes inward, shifting or compressing structures within the chest and upper abdomen. The heart may be pushed backward, which exerts pressure on the esophagus, the tube connecting the throat to the stomach.
The pressure can directly impact the gastroesophageal junction, the area where the esophagus meets the stomach. This connection is regulated by the lower esophageal sphincter (LES), a ring of muscle that acts as a valve to prevent stomach contents from backing up. Compression can distort the natural angle of this junction, which compromises the effectiveness of the LES.
Furthermore, structural displacement can contribute to a hiatal hernia, where a portion of the stomach protrudes upward into the chest cavity through the diaphragm opening. The diaphragm, the large muscle separating the chest from the abdomen, is also affected by the reduced volume and abnormal pressure from the depressed sternum.
Common Gastrointestinal Symptoms
The anatomical distortions caused by pectus excavatum frequently manifest as Gastroesophageal Reflux Disease (GERD). Patients often experience acid reflux and heartburn because the compromised lower esophageal sphincter cannot prevent stomach acid from flowing back into the esophagus. This acid exposure leads to significant discomfort, especially after eating or when lying down.
Difficulty swallowing, medically termed dysphagia, is another symptom reported by some individuals. The compression and displacement of the esophagus by the sternum or the heart can interfere with the normal passage of food. This feeling of food “getting stuck” is a direct result of the external pressure on the digestive tube.
The crowding effect on the upper abdomen can also lead to early satiety. Since the stomach is physically compressed or displaced, its capacity may be reduced, causing a person to feel full quickly after consuming a small amount of food. These digestive issues are often reported in patients with more severe degrees of sternal depression.
Managing Pectus-Related GI Issues
Management of pectus-related gastrointestinal problems typically follows two pathways: symptomatic relief and corrective intervention. The first approach involves standard medical treatments aimed at controlling symptoms. This often includes medications like proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid production and minimize reflux damage.
Dietary and lifestyle adjustments, such as avoiding trigger foods and elevating the head of the bed, are also standard conservative recommendations. While these methods effectively manage GERD symptoms, they do not address the underlying physical cause. They offer temporary relief without correcting the anatomical compression.
The definitive pathway is the surgical correction of the pectus excavatum, most commonly using the Nuss or Ravitch procedures. These operations aim to reposition the sternum and restore the normal anterior-posterior diameter of the chest. By correcting the skeletal deformity, the pressure on the esophagus, gastroesophageal junction, and stomach is alleviated. Many patients report that their associated GI symptoms, such as reflux and dysphagia, resolve completely after surgical repair.