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Overview of Obstructions of the Esophagus

by Michael C. DiMarino, MD

The esophagus can be narrowed or completely obstructed (blocked). In rare cases, the cause is hereditary (for example, lower esophageal rings—see Lower Esophageal Ring) or an esophageal web (see Esophageal Webs). In most cases, the cause is progression of an injury to the esophagus or tumor growth. Food and foreign bodies (see Bezoars and Foreign Bodies of the Digestive Tract) may block the esophagus as well. Injuries that can progress to blockage can result from damage caused by the repeated backflow of acid from the stomach (gastroesophageal reflux or GERD—see Gastroesophageal Reflux (GERD)), usually over years. Injury can also result from damage caused by drugs taken in pill form or ingestion of corrosive substances (see Overview of Injuries of the Esophagus). Narrowing may also be caused by compression against the outside of the esophagus. Compression can result from a number of causes, such as enlargement of the left atrium of the heart, an aortic aneurysm, an abnormally formed blood vessel (dysphagia lusoria—see Dysphagia Lusoria), an abnormal thyroid gland, a bony outgrowth from the spine, or cancer—most commonly lung cancer. Another serious cause of narrowing is noncancerous (benign) and cancerous (malignant) tumors of the esophagus (see Esophageal Tumors That Are Noncancerous and see Esophageal Cancer).

Because all these conditions decrease the diameter of the esophagus, people with one of them usually have difficulty swallowing solid foods—particularly meat and bread. Difficulty in swallowing liquids develops much later, if at all.

To diagnose a blockage in the esophagus, doctors look in the esophagus with a flexible tube (upper endoscopy—see Endoscopy). During the endoscopy, doctors take tissue samples to analyze under a microscope (called a biopsy). A type of barium x-ray called a barium swallow (see X-Ray Studies) is sometimes done.

Treatment and outcome depend on the cause.