An esophageal lesion refers to any abnormal area or change that develops on the lining of the esophagus. This tube transports food and liquids from your throat to your stomach. Lesions can vary significantly in their appearance, size, and underlying nature.
What Are Esophageal Lesions?
The esophagus is a muscular tube, approximately 25 to 30 centimeters long, connecting the throat to the stomach. Its primary function is to transport swallowed food and liquids through rhythmic muscle contractions called peristalsis. The esophagus has five layers: the epithelium, lamina propria, submucosa, muscularis propria, and serosa (or adventitia).
Esophageal lesions are abnormalities that can occur within these layers. They range from inflammatory changes like esophagitis (irritation and swelling of the lining) to distinct formations such as ulcers, polyps, cysts, or tumors. Lesions can be superficial, affecting only the innermost lining (mucosa), or extend into deeper layers of the esophageal wall.
Causes and Risk Factors
Chronic irritation or specific conditions are common causes of esophageal lesions. Gastroesophageal reflux disease (GERD) is a frequent cause, where stomach acids repeatedly flow back into the esophagus, irritating its lining. This chronic acid exposure can lead to inflammation, known as reflux esophagitis, and may also result in cellular changes over time.
Infections can also cause esophageal lesions, especially in individuals with weakened immune systems. Certain medications taken by mouth, particularly if swallowed with little water or while lying down, can damage esophageal tissue. Examples include aspirin, ibuprofen, some antibiotics (like tetracycline and doxycycline), and bisphosphonates. Lifestyle factors also contribute. Smoking can increase reflux risk and decrease saliva production. Excessive alcohol consumption directly damages the esophageal lining and relaxes the lower esophageal sphincter, increasing acid reflux and lesion formation.
Recognizing the Signs
Esophageal lesions can cause various symptoms, with their nature and intensity depending on the lesion’s type, size, and location. Difficulty swallowing, known as dysphagia, is a common indicator, feeling like food is stuck in the throat or chest. Painful swallowing, or odynophagia, can also occur during eating or drinking.
Many individuals experience heartburn, a burning sensation behind the breastbone, often from stomach acid reflux. Chest pain or pressure, sometimes mistaken for heart issues, can also be a sign. Unexplained weight loss may occur if swallowing difficulties or pain reduce food intake. A chronic cough or hoarseness can also be associated with esophageal irritation, especially if stomach acid travels higher into the throat.
Diagnosing Esophageal Lesions
Diagnosing esophageal lesions involves diagnostic procedures to visualize the esophagus and assess its function. Upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a common initial step. During this procedure, a thin, flexible tube with a camera is guided down the throat to visually inspect the lining of the esophagus, stomach, and the beginning of the small intestine. If an abnormal area is found, a biopsy—a small tissue sample—can be taken for microscopic examination to determine the lesion’s nature.
A barium swallow, or esophagography, involves drinking a liquid containing barium, which coats the esophageal lining for X-ray visualization. This test helps identify structural abnormalities like narrowing (strictures), ulcers, or masses. Esophageal manometry evaluates muscle function and detects swallowing disorders by measuring muscle contractions and relaxations with a pressure-sensitive tube. pH monitoring can also measure how often and for how long stomach acid enters the esophagus, often over 24 to 48 hours using a small tube or wireless capsule.
Treatment Approaches
Treatment for esophageal lesions is individualized, depending on the cause, type, and severity. For conditions like reflux esophagitis caused by GERD, initial management often involves lifestyle modifications. These include avoiding large or fatty meals, refraining from eating close to bedtime, quitting smoking, and reducing alcohol consumption. Medications such as proton pump inhibitors (PPIs) are frequently prescribed to reduce stomach acid production, allowing the esophageal lining to heal.
When lesions cause esophageal narrowing, endoscopic therapies like esophageal dilation may be used. This procedure uses balloons or bougies passed through an endoscope to gently stretch constricted areas. For certain lesions, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) can remove abnormal tissue.
Ablation techniques, such as radiofrequency ablation, cryotherapy, or argon plasma coagulation, may destroy precancerous or superficial abnormal cells. For more advanced or complex lesions, surgical intervention may be considered to remove the affected esophageal portion or address underlying issues like a hiatal hernia.