Esophageal pain: understand the causes and how to treat

There are diseases that can cause injuries and affect the structure of the esophagus, an organ that has the important function of transporting food and liquids between the mouth and the stomach, and some of the main ones include gastroesophageal reflux, esophagitis, tumor, spasms, infections, injuries, for example.

The main symptoms caused by these diseases are chest pain, heartburn, reflux, difficulty in swallowing or a feeling of a bolus in the throat area. Often, the pain is intense and confused with cardiac, pulmonary or muscular diseases, so it is always necessary to have a medical evaluation to perform tests such as digestive endoscopy, manometry, ultrasound or radiography with contrast of the region, which identify changes in the region. organ structure and rule out other causes. Understand more about the other causes of chest pain.

1. Gastroesophageal reflux disease

Also known as GERD, this disease is caused by the reflux of the contents of the stomach into the esophagus, which should not happen, as the tissue of this organ is not prepared to receive excess acidity.

• Symptoms: the main symptoms of gastroesophageal reflux are burning in the chest, heartburn, bitter taste in the mouth, coughing at night, recurrent laryngitis, and in the most severe cases, there may be pain in the chest, pain to swallow (odynophagia) and difficulty swallowing (dysphagia). Treatment: the use of drugs to decrease the acidity of gastric juice is recommended, such as Omeprazole, Pantoprazole, Esomeprazole or Ranitidine, for example, and it is also necessary to make changes in habits, such as avoiding foods that facilitate reflux, such as fried foods, fats, mint, pepper, coffees, teas, tomatoes, acidic foods, in addition to avoid eating too much, lie down right after eating and wear tight clothes.

If gastroesophageal reflux is not treated properly, some of the possible complications are esophagitis, Barrett's esophagus, narrowing of the esophagus and even cancer. Learn more about what it is and how to identify gastroesophageal reflux.

2. Esophagitis

Esophagitis is inflammation of the esophagus, a complication that affects some people with gastroesophageal reflux disease. This inflammation increases the risk of causing Barrett's esophagus, which arises when the inflamed cells undergo a transformation, called metaplasia, to withstand frequent exposure to acidity, and which has an increased risk of causing esophageal cancer.

Other causes of esophagitis include yeast infections, frequent vomiting, use of drugs such as aspirin, anti-inflammatories and antibiotics, such as Clindamycin, hiatus hernia or ingestion of caustic or acidic substances, for example.

• Symptoms: pain or burning in the chest, pain or difficulty swallowing, bitter taste in the mouth, cough, frequent laryngitis. Treatment: if caused by reflux, the treatment of esophagitis is also done by inhibiting stomach acidity, with medications such as Pantoprazole, Omeprazole and Ranitidine, for example, in addition to changes in eating habits. If caused by infections, medications such as antibiotics, antifungals or antivirals are indicated until the lesion heals. In the case of irritation by drugs, substances or radiation, it may be necessary to dilate the esophagus, if its function has been compromised.

Find out more details about the types of esophagitis and how to treat it.

3. Esophageal spasm

It is not known with certainty what is the cause of esophageal reflux, however there are factors that can trigger an uncoordinated activity of this organ, causing painful and abnormal contractions of the esophagus, such as very hot or cold foods.

To confirm this disease, the doctor may order tests such as manometry, which detects the pressure of the esophagus, in addition to radiography with contrast and endoscopy.

• Symptoms: they are mainly difficulty in swallowing and pain in the chest, which can happen during sleep, worsen after meals, and be accompanied by burning, reflux and difficulty in swallowing. In some cases, the pain can be so severe that it can simulate an acute myocardial infarction. Treatment: pain can be relieved with antacids and, to control spasms, the doctor may recommend medications such as nitrates, hydralazine, calcium channel blocker, botulinum toxin and anxiolytics, for example.

4. Esophageal cancer

The esophageal tumor is rare, and in most cases, it is related to the existence of reflux disease and Barrett's esophagus, however, other risk factors are smoking, alcohol consumption, caustic injury, HPV infection, obesity and esophageal reflux.

• Symptoms: the main symptom is the difficulty in swallowing food, which gradually gets worse, starting with solid foods and can reach liquids. Other signs and symptoms that may appear are weight loss, hoarseness, pain when swallowing and anemia, which can make the person feel tired. Treatment: treatment is indicated by the doctor according to the type and severity of the lesion and usually includes surgery to remove the tumor, in addition to chemotherapy or radiotherapy.

Learn more about how to identify and treat esophageal cancer.

5. Achalasia

Achalasia is a disease caused by the injury or loss of neurons responsible for innervating the esophageal muscles. In this way, the esophagus loses its ability to relax during swallowing and to perform peristalsis, which are the waves of movement of the digestive tube formed to take food in the right direction, up to the stomach and intestines. Thus, in achalasia there is a gradual esophageal dilation and deformity, which can worsen as time passes.

• Symptoms: the main symptoms are difficulty in swallowing, reflux, chest pain and weight loss. Treatment: although there is no cure, the doctor may recommend treatments to reduce pressure in the esophagus and symptoms, such as nitrates or hydralazine. Esophageal dilation or myotomy surgeries are alternatives to facilitate emptying of the esophagus in the most severe cases. In the latter case, removal of the esophagus may be necessary.

Achalasia is caused by autoimmune causes, however, Chagas disease can also cause nerve damage and cause similar dilation in patients with this infection. To confirm achalasia, the doctor may recommend exams such as esophageal manometry, to detect changes in pressure, in addition to endoscopy and radiography with esophageal contrast.

6. Diverticles

Diverticula are changes in the structure of the esophagus that are usually small, but can grow and become able to retain saliva and food.

• Symptoms: when they are large, diverticula can cause difficulty in swallowing, bad breath and aspiration of food into the lungs. Treatment: Surgery may be indicated to remove the most bulky diverticula or cause symptoms.

In addition to diverticula, other changes in the structure of the esophagus that may arise are rings and membranes along the organ, as well as polyps or benign tumors, which can make it difficult to swallow food, and can have congenital or inflammatory causes.

7. Injuries to the esophagus

An important cause of pain in the esophagus, although rare, is the formation of injuries or perforation, which happen both due to the presence of intense vomiting, and during procedures such as endoscopy or placement of nasogastric tubes, trauma in accidents or even due to corrosion. caused by esophagitis or cancer.

• Symptoms: there is severe pain located in the chest, which worsens when breathing or coughing, and blood may leak during vomiting. There may also be inflammation of the mediastinum, an area where other important organs such as the heart and lungs are located, which is dangerous and can put a person's life at risk. Treatment: aspiration of secretions with a tube is necessary, use of antibiotics and avoid eating until the lesions heal. When the wound is large or cannot be contained, surgery for correction is indicated.

In addition to the formation of lesions, there may be impaction of food or some foreign body that can be lodged in the esophagus and cause intense pain and inability to eliminate the secretions formed. In some cases, it may be necessary to remove the cause by endoscopy.