Thoracic conditions may occur in different organs located in or surrounding the chest. Common problems include difficulty with swallowing, esophageal motility and cancers of the chest.
Gastroesophageal Reflux Disease (GERD)
Also called “acid reflux,” GERD is a common condition that affects about 20% of people in the United States and accounts for 75% of esophageal diseases. This type of reflux occurs when the valve at the end of the esophagus does not close properly, allowing acidic juices to move upward through the esophagus to the throat and mouth.
This type of hernia occurs when the stomach protrudes through the diaphragm into the chest. The cause is often unknown, but hiatal hernia may develop from the weakening of diaphragm muscles around the esophagus. Common symptoms of hiatal hernias include heartburn, difficulty swallowing, chest pain, anemia or chronic cough.
Chronic GERD can damage the lower esophageal sphincter and lead to a condition called Barrett’s esophagus. This condition is characterized by thickened, red lining in the esophagus. Patients with Barrett’s esophagus have an increased risk of developing esophageal cancer.
Reflex-Related Adult-Onset Asthma
Chronic GERD can cause asthma-like symptoms in adults who do not have a history of asthma or respiratory problems. Acid in the esophagus or trachea can cause coughing, wheezing and pneumonia, and may improve with antacid therapy. Chronic aspiration of gastric acid and bile (non-acidic fluid), which typically occurs at night when patients are lying down, can severely damage the lungs and vocal cords.
Peptic Esophageal Stricture
Esophageal stricture is a narrowing of the esophagus. This narrowing or tightening is caused by chronic GERD and occurs in 1% to 5% of patients with esophagitis (irritation and inflammation of the lining of the esophagus). Patients with peptic esophageal stricture may have difficulty swallowing and feel like food is stuck in their throat.
Previous Failed Antireflux Surgery
Patients who experience recurrent symptoms after antireflux surgery may need a corrective procedure. This “redo” procedure aims to prevent the reflux of acid and bile (non-acidic juice) from the stomach into the esophagus. A procedure called Laparoscopic Nissen Fundoplication is most frequently used.
Esophageal Motility Disorders
This condition affects the function of the nerves around the esophagus. With achalasia, the esophagus does not function well enough to effectively push food through to the stomach. The lower esophageal sphincter (valve between the esophagus and the stomach) cannot relax or open to allow food to pass. The goal of treatment is to improve symptoms by widening the obstruction where the esophagus meets the stomach.
Scleroderma is a rare autoimmune disease affecting the connective tissues of the body. The body’s immune system is designed to defend against infection, but patients with scleroderma have a response that hardens and thickens tissue in skin or other organs. Scleroderma can affect the skin, muscles, blood vessels, heart, lungs and digestive tract.
Diffuse Esophageal Spasm
Uncoordinated contractions of the muscles in the esophagus are known as esophageal spasms. This abnormal muscle movement prevents food from moving correctly through the esophagus and into the stomach. Diffuse esophageal spasms may be related to triggers like hot or cold foods, and can cause chest pain, heartburn or painful swallowing.
Abnormal, intense contractions during swallowing occur in patients with Nutcracker esophagus. The condition is usually caused by chronic GERD and causes chest pain, difficulty swallowing and heartburn. Treatment involves addressing the underlying GERD problem.
Hypertensive Lower Esophageal Sphincter
This condition occurs when the lower esophageal sphincter (LES) is in a state of increased contraction pressures. Hypertensive LES can be caused by chronic GERD, although the cause is often unknown. Treatment options include Botox® injections to relax the sphincter or surgery for severe cases of dysphagia.
This condition is believed by be a form of food allergy that causes difficulty swallowing. With eosinophilic esophagitis, the lining of the esophagus develops an accumulation of eosinophils (a type of white blood cell associated with allergic immune response). The accumulation causes narrowing of the esophagus and swallowing becomes difficult. In severe cases, food may become impacted and require surgical removal.
Other Esophageal Diseases
This life-threatening condition occurs when the esophagus tissue is torn, leading to infection. The majority of esophageal perforations are caused by instrumentation following an upper endoscopy and dilation of the esophagus for treatment of conditions such as esophageal peptic stricture, achalasia or esophageal cancer. The esophagus can also be perforated following severe vomiting. Without treatment, esophageal perforation can result in sepsis (severe infection) and death.
The esophagus and trachea (windpipe) are separate parts of the human anatomy. Tracheoesophageal fistulas can be caused when any disease or trauma in the trachea or esophagus causes erosion into the wall of the other organ. This abnormal connection allows food or liquids that are swallowed to be inhaled into the lungs, and can result in difficulty swallowing, coughing and, pneumonia.
A Zenker’s diverticulum is a pouch at the back of the throat that develops where the lower portion of the throat meets the top of the esophagus. This condition develops when the muscles that control swallowing do not properly relax. Over time, food can accumulate in the pouch causing it to increase in size.
Chronic GERD can cause inflammation and damage to the lower esophagus. When the damage heals, a scar called Schatzki’s ring can develop. This condition is usually asymptomatic until it advances to a point where food becomes impacted, causing severe chest pain and difficulty swallowing.
Cancers in the Chest
Esophageal cancer usually starts in the cells of the esophageal lining, occurring anywhere along the length of the esophagus. According to the American Cancer Society, this type of cancer is relatively rare but about 20,000 Americans are diagnosed each year.
Lung cancer is the second most common type of cancer in the United States, according to the American Cancer Society. Smoking is the most significant risk factor, but about one quarter of people diagnosed with lung cancer have never smoked. The two main types of lung cancer are small-cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer is more common and develops slowly. Small-cell lung cancer grows faster and is often in an advanced stage by the time it is diagnosed.