Esophageal obstruction can be complete or partial and is caused by benign or malignant tumors or foreign bodies located within the lumen, wall (intramural) or outside the wall (extrinsic obstruction) of the esophagus. Intraluminal causes besides the above-mentioned etiologies include strictures secondary to corrosive ingestion, esophagitis (secondary to gastroesophageal reflux or infections) and esophageal webs which can be congenital or acquired. Intramural tumors can cause obstruction by narrowing the esophagus. Similarly, extrinsic factors like thyromegaly, cervical swellings, anomalous blood vessels (dysphagia lusoria), aneurysms of the aorta, left atrial enlargement, vertebral osteophytes, and malignant pulmonary tumors can compress the esophagus leading to obstruction of its lumen.

Patients present with progressively increasing dysphagia to either solids or liquids depending upon the etiology of the obstruction. In malignant lesions, the dysphagia to solids is the initial symptom, progressing to semi-solids and finally to liquids [1]. Anorexia, loss of appetite, weight loss, asthenia and nutritional deficiencies develop over a period of time. Drooling may be noticed if there is a complete luminal obstruction. This leads eventually to cachexia and influences the patient's quality and duration of life [2] [3]. The nutritional status in these patients determines the prognosis [4]. Patients with partial esophageal obstruction may have a sensation of food or foreign body getting stuck in the throat.

• Pain

  Patients experience diffuse retrosternal chest pain due to esophageal spasm and obstruction. [explainmedicine.com]

  Early (within 48 hours) procedure-related complications occurred in 4 of 13 patients and consisted of minor, transient chest pain that resolved within 6 hours (3 patients) and endoscopic stent dislodgment into the stomach (1 patient). [ncbi.nlm.nih.gov]

• Weight Loss

  Because of this property, guar gum has been used in "weight loss" tablets marketed by several pharmaceutical manufacturers. These tablets undergo expansion in the stomach and are expected to cause early satiety. [ncbi.nlm.nih.gov]

  Anorexia, loss of appetite, weight loss, asthenia and nutritional deficiencies develop over a period of time. Drooling may be noticed if there is a complete luminal obstruction. [symptoma.com]

  A 37-year-old man presented after 1 year of dysphagia and weight loss, and was found to have complete esophageal obstruction, not allowing even passage of guidewire. [acgcasereports.gi.org]

  Weight loss. Regurgitation/reflux of food or liquids. Pain In upper chest. Hiccups. Choking. Shortness of breath. Fever. Causes Esophageal blockage may be a result of many factors. [medanta.org]

• Inflammation

  Eosinophilic esophagitis is an immune mediated process and can cause widespread inflammation throughout the entire length of the esophagus. [healthhype.com]

  Eosinophilic esophagitis refers to an inflammation along the entire length of the esophageal tube caused by the immune system. [phaa.com]

  Responsible Research Success stories Experience Science History & Origins Organization Organization Leadership Administration Officers and Representatives Society of Friends Helmholtz Helmholtz The MDC as part of Helmholtz Future Topic: Immunology & Inflammation [mdc-berlin.de]

  […] such as: Ring of tissue that forms in the lower part of the esophagus—Schatzkis ring Narrowing of the esophagus caused by scar tissue— esophageal stricture Upper part of the stomach moves up through a small opening into the chest— hiatal hernia Chronic inflammation [winchesterhospital.org]

  Over time, the acid and peptic stomach juices injure the esophagus, causing inflammation and then scarring. The fibrous scar then contracts and narrows the esophageal opening. [gicare.com]

• Anemia

  Some patients may induce vomiting to get rid of the obstruction. [2] History of benign esophageal strictures Schatzki rings, acid strictures and esophageal webs (due to iron deficiency anemia) can cause external compression and esophageal obstruction. [explainmedicine.com]

  Over time, this blood loss can lead to anemia (low red blood cell levels), which can make a person feel tired. Having one or more of the symptoms above does not mean you have esophageal cancer. [cancer.org]

• Surgical Procedure

  Multiple endoscopic techniques as well as radical surgical procedures have been developed with the goal of restoring a patent esophageal lumen. [ncbi.nlm.nih.gov]

  A surgical procedure can repair your LES and help prevent GERD symptoms. Treatment can correct benign esophageal stricture and help relieve the associated symptoms. However, the condition can occur again. [healthline.com]

• Hoarseness

  Other symptoms Other possible symptoms of cancer of the esophagus can include: Hoarseness Chronic cough Vomiting Hiccups Bone pain Bleeding into the esophagus. This blood then passes through the digestive tract, which may turn the stool black. [cancer.org]

  More advanced cases have the following symptoms: • difficulty swallowing (dysphagia); • feeling of food getting stuck in throat; • unintentional weight loss; • pain in throat, midchest and between shoulder blades; • hoarseness; • hiccups; and • vomiting [fortherecordmag.com]

  Symptoms by local tumor effects – Reflux – Odynophagia – Chest pain – Back pain – Weight loss – Dysphagia – GI bleeding Symptoms by advanced effects – Hoarseness or other voice changes by recurrent laryngeal nerve invasion – Horner’s syndrome by invasion [clinicaladvisor.com]

• Dysphagia

  The median dysphagia score dropped from 3 (able to eat liquids only) to 1 (some dysphagia with solid food), and seven of the eight patients had an improvement of at least two grades of dysphagia. Mean survival was 87 days (range 17-226). [ncbi.nlm.nih.gov]

• Vomiting

  Patients with food or foreign body impaction can have retching and or vomiting. [explainmedicine.com]

  We report the case of a patient who presented with complaints of abdominal discomfort and recurrent vomiting after ingestion of an anhydrous protein pill. Esophagoscopy revealed the presence of a pill much larger than initially ingested. [ncbi.nlm.nih.gov]

  Vomiting continued and the dysphagia worsened. The patient then underwent an upper gastrointestinal endoscopy (using Olympus GIF-V2, Olympus Optical Co. [bmcgastroenterol.biomedcentral.com]

  Symptoms The symptoms of esophageal obstruction include the following: Difficulty in swallowing Chest pain after swallowing Inability to swallow Vomiting after swallowing Regurgitation of food Hiccups Choking Bleeding in vomit or stool Acid reflux Shortness [home-remedies-for-you.com]

  It can be accompanied by a feeling of discomfort in the chest, pain, srygivaniem and vomiting, gipersalivaciej, acidic or bitter belch, loss of body mass index. [omedicine.info]

• Odynophagia

  Elderly patients are at especially at risk because they often have few teeth. [1] Odynophagia Partial obstruction of the esophagus can cause odynophagia. [1] Sialorrhea Sialorrhea refers to excessive accumulation of saliva, because patients cannot swallow [explainmedicine.com]

  A blockage of the esophagus may cause a number of symptoms including discomfort or pain when eating and swallowing ( odynophagia ), difficulty swallowing ( dysphagia ) and regurgitation. [healthhype.com]

  Case Report A 43-year old man presented to the emergency room with a one-day history of odynophagia and dysphagia. He had taken 3 tablets of nelfinavir obtained from his partner's medication cabinet in a suicidal attempt. [ispub.com]

  There may be pain or discomfort during eating and swallowing, a condition referred to as odynophagia. Difficulty in swallowing (technically known as dysphagia) may occur. In some cases, regurgitation of food may also occur. [phaa.com]

  […] in throat Gagging Irritability Pain in neck, throat, or chest Recurrent aspiration pneumonia Respiratory distress Stridor Tachypnea or dyspnea Vomiting Wheezing TABLE 1 Symptoms of Esophageal Foreign Bodies Blood in saliva Coughing Drooling Dysphagia/odynophagia [aafp.org]

• Hiccup

  Hiccups. Choking. Shortness of breath. Fever. Causes Esophageal blockage may be a result of many factors. [medanta.org]

  Other symptoms Other possible symptoms of cancer of the esophagus can include: Hoarseness Chronic cough Vomiting Hiccups Bone pain Bleeding into the esophagus. This blood then passes through the digestive tract, which may turn the stool black. [cancer.org]

  Persistent hiccups. Weight loss as very less amount of food goes down in the stomach. The food is often vomited out soon after eating. Shortness of breath. [tandurust.com]

  Symptoms The symptoms of esophageal obstruction include the following: Difficulty in swallowing Chest pain after swallowing Inability to swallow Vomiting after swallowing Regurgitation of food Hiccups Choking Bleeding in vomit or stool Acid reflux Shortness [home-remedies-for-you.com]

  More advanced cases have the following symptoms: • difficulty swallowing (dysphagia); • feeling of food getting stuck in throat; • unintentional weight loss; • pain in throat, midchest and between shoulder blades; • hoarseness; • hiccups; and • vomiting [fortherecordmag.com]

• Aphagia

  A case report is presented of an 86-year-old man in a very poor general condition with a 10-year history of a Zenker's diverticulum as a cause of a complete obstruction of the esophagus with subsequent aphagia and massive cachexia. [ncbi.nlm.nih.gov]

• Chest Pain

  Early (within 48 hours) procedure-related complications occurred in 4 of 13 patients and consisted of minor, transient chest pain that resolved within 6 hours (3 patients) and endoscopic stent dislodgment into the stomach (1 patient). [ncbi.nlm.nih.gov]

  Patients experience diffuse retrosternal chest pain due to esophageal spasm and obstruction. [explainmedicine.com]

  This causes chest pain and inability to swallow saliva. Attempts to relieve the obstruction by inducing vomiting at home are usually unsuccessful. Patients with complete esophageal obstruction can breathe and are not at risk of suffocation. [medicinenet.com]

• Retrosternal Chest Pain

  Patients experience diffuse retrosternal chest pain due to esophageal spasm and obstruction. [explainmedicine.com]

• Confusion

  LEFT: normal esophagusRIGHT: Mediastinal nodes (arrows) displace esophagus to right Due not confuse normal esophageal irregularities for impressions by lymphnodes. On the left a normal esophagus. [radiologyassistant.nl]

• Convulsions

  Mallory-Weiss tear A Mallory-Weiss tear results from prolonged and forceful vomiting, coughing or convulsions. [radiologyassistant.nl]

The workup in a case of this disease includes history taking, complete physical and neurological examination, followed by laboratory tests, endoscopic evaluation, and imaging studies. Anamnestic data will provide information on the foreign body or caustic ingestion and details about the onset, duration, progress and degree of dysphagia. Physical examination will help detect nutritional abnormalities, thyromegaly, and cardiac or pulmonary etiology of the swallowing dysfunction. A thorough neurological examination is required to exclude neuromuscular causes of dysphagia.

Laboratory tests such as vitamin B12 levels, thyroid stimulating hormone levels (TSH) and creatine kinase should be ordered as part of the workup.

A plain X-ray chest may reveal a lung tumor or an enlarged left atrium compressing the esophagus. Non-invasive imaging studies like videofluoroscopy [5] and barium swallow help to diagnose mucosal and obstructive lesions while computed tomography and magnetic resonance imaging are required to delineate the extent of the obstructive growths and can also detect anomalous blood vessels.

Esophagoscopy is the gold standard test to detect the cause of the esophageal obstruction [6], to remove a foreign body, dilate a stricture or obtain tissue for histological evaluation.

If gastroesophageal reflux is suspected, then 24 hour pH monitoring will be required to diagnose the cause. Electromyography [7] and manometry can also be performed if indicated by history and physical examination findings.

• Esophageal Motility Disorder

  [1,2] History of esophageal motility disorders Achalasia and other esophageal motility disorders can precipitate esophageal obstruction. [2] [explainmedicine.com]

  foreign body lodgment; cause of obstructive bloat. esophageal hyperkeratosis hyperkeratotic thickening of the esophageal mucosa due usually to hypovitaminosis A or chlorinated naphthalene poisoning. esophageal motility disorders esophageal neoplasm [medical-dictionary.thefreedictionary.com]

  Risk Factors Factors that may increase your chances of steakhouse syndrome: Not chewing your food completely Drinking too much alcohol Wearing dentures Having a physical problem that affects how food moves down the esophagus: Esophageal motility disorder [winchesterhospital.org]

  Semin Thorac Cariovasc Surg 1999;11:326-36 70077-8/abstract)/ “Achalasia and esophageal motility disorders,” STS Patient Information, accessed 9-20-06. Rice TW, Baker ME. Midthoracic esophageal diverticula. [my.clevelandclinic.org]

  Journal of neurogastroenterology and motility. Jul 2013;19(3):281-294. 3.Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. [gi.dxy.cn]

The rates of reintervention were similar in both treatment groups, as were the 30-day mortality rates. [ncbi.nlm.nih.gov]

The nutritional status in these patients determines the prognosis. Patients with partial esophageal obstruction may have a sensation of food or foreign body getting stuck in the throat. [symptoma.com]

A more detailed subclassification of early esophageal cancer has been proposed for determining prognosis and selecting treatment. [clinicaladvisor.com]

Patients present with progressively increasing dysphagia to either solids or liquids depending upon the etiology of the obstruction. [symptoma.com]

Etiology  Large food bolus with no underlying cause  Strictures or stenosis  Carcinoma  Shatzki’s ring (15% of people have fibrous stricture near GE junction) [scribd.com]

However, the etiology remains unknown in many cases. [acgcasereports.gi.org]

Clinical Take Home Point: Given the weak evidence for the benefits of glucagon, the potential side effect of nausea/vomiting, and the fact that nearly 1/4 th of patients will have an anatomic etiology to their obstruction, avoid the use of glucagon and [rebelem.com]

Acute esophageal syndromes In the table on the left are etiologies of an acute esophageal syndrome. Boerhaave syndrome Boerhaave syndrome is rupture of the esophageal wall. [radiologyassistant.nl]

Esophageal food impaction: epidemiology and therapy. A retrospective study, observational study. Gastrointestinal Endoscopy. 2001;53:193-198. Gretarsdottir HM, Jonasson JG, Bjornsson ES. [appliedradiology.com]

"Esophageal food impaction: epidemiology and therapy. A retrospective, observational study". Gastrointestinal Endoscopy. 53 (2): 193–8. doi : 10.1067/mge.2001.112709. PMID 11174291. ^ a b c d Kerlin P, Jones D, Remedios M, Campbell C (2007). [en.wikipedia.org]

Conclusion Our understanding of the pathophysiology and treatment of achalasia has increased significantly. [hon.ch]

“Pathophysiology and treatment of Barrett's esophagus”. World J Gastroenterol. vol. 16. 2010. pp. 3762-72. Lagarde, SM, ten Kate, FJ, Richel, DJ. “Molecular prognostic factors in adenocarcinoma of the esophagus and gastroesophageal junction”. [clinicaladvisor.com]

In 1 patient with an esophagorespiratory fistula, the prosthesis successfully occluded the fistula and prevented aspiration or pulmonary infection until the patient's death. [ncbi.nlm.nih.gov]

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