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Overview of Obstructions of the Esophagus

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, Perelman School of Medicine at The University of Pennsylvania

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach.

The esophagus can be narrowed or completely obstructed (blocked). In most cases, the cause is progression of an injury to the esophagus or tumor growth. Food and foreign bodies may block the esophagus as well. Injuries that can progress to obstruction can result from damage to the esophagus caused by the repeated backflow of acid from the stomach (gastroesophageal reflux or GERD), usually over years. Obstruction can also be caused by damage to the esophagus that occurs after swallowing a corrosive substance (erosive esophagitis) or rarely after inflammation of the esophagus caused by a pill that gets stuck in the esophagus for a period of time.

Narrowing may also occur when something presses against (compresses) the outside of the esophagus. Compression can result from a number of causes, such as

Other serious causes of narrowing are cancerous tumors and noncancerous tumors of the esophagus.

Occasionally, the cause is hereditary (for example, lower esophageal rings or an esophageal web. These disorders usually cause only partial obstruction.

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

Diagnosis

  • Upper endoscopy

  • Biopsy

  • Barium swallow x-rays

To diagnose a blockage in the esophagus, doctors do an upper endoscopy. In this procedure, doctors examine the esophagus using a flexible tube called an endoscope. During the endoscopy, doctors take tissue samples to analyze under a microscope (called a biopsy). Doctors may also do a barium swallow. In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see.

Treatment and outcome depend on the cause of the narrowing or blockage.