An esophageal lesion refers to any area of abnormal tissue, damage, or growth that develops within the lining of the esophagus. This muscular tube transports food and liquids from the throat down to the stomach. Any disruption to its delicate surface can interfere with swallowing and digestion. These abnormalities warrant medical evaluation to determine their nature and prevent potential complications.
Recognizing the Signs
The presence of an esophageal lesion often becomes apparent through difficulty or pain associated with eating and drinking. The most common symptom is dysphagia, the sensation of food feeling stuck in the chest or throat. This trouble with swallowing typically begins subtly with solid foods and may gradually progress to include softer foods and liquids.
A related symptom is odynophagia, which is the experience of actual pain while swallowing. This pain may be felt a few seconds after consuming food or liquid, occurring when the item reaches the damaged or narrowed area of the esophagus. Many patients also report persistent heartburn or a burning sensation in the chest that does not resolve with common over-the-counter medications.
Other physical manifestations can include a chronic cough, hoarseness, or the regurgitation of undigested food. When the lesion causes bleeding, a patient may experience anemia, leading to fatigue, or note black, tar-like stools. Unintended weight loss is another frequent indication, often occurring because discomfort or difficulty with swallowing causes the person to eat less.
Common Causes and Types
The majority of esophageal lesions are caused by chronic exposure to stomach contents, known as gastroesophageal reflux disease (GERD). When the lower esophageal sphincter is weakened, stomach acid repeatedly flows back up, irritating the esophageal lining. This persistent chemical injury is the most common cause of esophageal ulcers and strictures.
An esophageal ulcer is an open sore or erosion that forms as the acid breaks down the protective mucosal layer. If chronic inflammation leads to scarring and fibrosis, it can result in an esophageal stricture, an abnormal narrowing of the tube that makes swallowing difficult. Chronic reflux can also lead to a cellular change called Barrett’s Esophagus.
Barrett’s Esophagus is a condition where the normal stratified squamous cells lining the lower esophagus are replaced by columnar cells (metaplasia). This change is considered precancerous and is the primary precursor to esophageal adenocarcinoma, a malignant lesion. Other types of growths include polyps, which are discrete, protruding masses typically benign and often associated with GERD.
In addition to acid reflux, lesions can stem from infectious agents. These include the fungus Candida, or viral infections like Herpes Simplex Virus (HSV) or Cytomegalovirus (CMV). Physical trauma, such as swallowing a caustic substance or thermal injury from hot liquids, can also cause significant damage and scarring. Medical treatments, including radiation therapy directed at the chest, can induce inflammation and the formation of strictures as a long-term side effect.
Diagnostic Procedures
A physician investigates a suspected esophageal lesion by combining a review of symptoms with direct visual inspection and specialized imaging. The primary diagnostic procedure is an upper endoscopy, also called an esophagogastroduodenoscopy (EGD). During this outpatient procedure, performed under sedation, a thin, flexible tube equipped with a light and camera is passed through the mouth and down the esophagus.
The endoscope allows the doctor to visually examine the lining of the esophagus, stomach, and duodenum for abnormalities like inflammation, ulcers, strictures, or growths. If an abnormal area is identified, the physician can perform a biopsy by passing tiny instruments through the endoscope to remove tissue samples. These samples are sent to a laboratory for microscopic analysis to determine the exact nature of the lesion, including whether it is benign, inflammatory, or malignant.
Supplementary imaging tests are often used to assess the extent of damage or confirm a diagnosis. A Barium swallow, or upper GI series, involves the patient drinking a liquid containing barium, which coats the esophagus and makes its structure visible on an X-ray. This technique is helpful for identifying a narrowing or stricture that might not be easily traversed by an endoscope. For malignant or advanced lesions, Computed Tomography (CT) or Positron Emission Tomography (PET) scans may be used to determine the size, location, and potential spread of the abnormal tissue.
Managing and Treating Esophageal Lesions
Treatment strategies for esophageal lesions depend on the type and cause of the abnormality identified. For lesions driven by chronic acid reflux, such as ulcers and mild inflammation, medical management is the initial approach. This often involves proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid production, allowing the injured esophageal tissue to heal.
When a lesion has caused an esophageal stricture, treatment involves endoscopic dilation to mechanically widen the narrowed area. A specialized balloon or dilator is passed through the endoscope and gently inflated to stretch the scar tissue, restoring the ability to swallow effectively. This procedure may need to be repeated if the stricture recurs.
For precancerous conditions like Barrett’s Esophagus with dysplasia, endoscopic ablative therapies destroy the abnormal cells. Techniques such as Radiofrequency Ablation (RFA) deliver heat energy to the affected area, while Photodynamic Therapy (PDT) uses light-activated drugs to eradicate the abnormal tissue. Endoscopic mucosal resection (EMR) may also be used to remove small, visible lesions or polyps showing early signs of malignancy.
In cases where cancer is advanced, or the damage is severe and cannot be managed endoscopically, major surgical intervention may be required. An esophagectomy involves the removal of a portion or all of the esophagus, which is then reconstructed using a section of the stomach or large intestine. This complex surgery is reserved for advanced malignant disease or lesions posing a significant risk of perforation or bleeding.