Oesophageal disorders are a group of conditions that affect the tube connecting your mouth to your stomach, interfering with its ability to move food properly. From the common burning sensation of acid reflux to rare swallowing difficulties, these disorders can significantly impact daily life, making even simple meals uncomfortable or challenging.

Understanding Oesophageal Disorders

Oesophageal disorders are conditions that affect how the oesophagus, also called the food pipe, works. This hollow muscular tube is part of your digestive system and its main job is to carry food and liquids from your throat down to your stomach. When the oesophagus isn’t working properly, it can cause problems with swallowing, pain, or the uncomfortable backward flow of stomach contents.^[1]

The oesophagus moves food through rhythmic waves of muscular contractions called peristalsis. At the top and bottom of the oesophagus are bands of muscle called sphincters. The upper oesophageal sphincter sits where the throat meets the oesophagus, and the lower oesophageal sphincter is located just above where the oesophagus joins the stomach. These sphincters normally stay closed when you’re not swallowing, preventing food and stomach acid from flowing back up. When you swallow, both sphincters open briefly to allow food to pass through.^[5]

As people age, the strength of oesophageal contractions and the pressure in the sphincters naturally decrease. This makes older adults more prone to experiencing backflow of acid from the stomach, especially when lying down after eating.^[5]

Types of Oesophageal Disorders

There are many different types of oesophageal disorders, each affecting the oesophagus in unique ways. The most common is gastro-oesophageal reflux disease, or GERD. This happens when the lower oesophageal sphincter doesn’t close properly, allowing stomach acid and contents to flow backward into the oesophagus. This backward flow, called acid reflux, irritates the lining of the oesophagus and causes inflammation.^[1]

Achalasia is a condition where the lower oesophageal sphincter doesn’t open or relax properly, preventing food from entering the stomach. Experts believe achalasia may be an autoimmune disease, meaning the body’s immune system mistakenly attacks its own tissues. The exact cause is unknown, but something damages the nerves that control the muscles in the oesophagus.^[1]

Barrett’s oesophagus develops in some people with chronic, untreated acid reflux. The lining of the bottom part of the oesophagus starts to look like stomach lining, and the cells begin to resemble intestinal cells. These changes occur where the oesophagus and stomach meet, and this condition is associated with a higher risk of oesophageal cancer.^[1]

Eosinophilic oesophagitis occurs when white blood cells called eosinophils become overabundant in the oesophagus. These cells are produced in bone marrow and actively promote inflammation, particularly inflammation caused by allergic reactions. The result is inflammation or swelling of the oesophageal lining. This condition is more common in patients with multiple allergies.^[1]

Oesophageal spasms are abnormal muscle contractions in the oesophagus. This rare, painful condition prevents food from reaching the stomach properly. The contractions can be unusually forceful or poorly coordinated.^[1]

Oesophageal strictures occur when the oesophagus becomes too narrow. Foods and liquids pass through slowly to the stomach, causing difficulty swallowing.^[1]

Hiatal hernias happen when the upper part of the stomach pushes up through an opening in the diaphragm (the muscle that separates the chest from the abdomen) and sits in the chest. This condition leads to more acid reflux.^[1]

Oesophageal diverticulum is an outpouching that occurs in a weak spot in the oesophagus, similar to a small pouch. People with achalasia are more prone to developing diverticula.^[1]

Oesophageal cancer exists in two main types: squamous cell carcinoma and adenocarcinoma. Smoking, radiation exposure, and HPV infection increase the risk of squamous cell carcinoma, while smoking and acid reflux increase the risk of adenocarcinoma.^[1]

Causes of Oesophageal Disorders

The causes of oesophageal disorders vary depending on the specific condition. For GERD, the primary cause is the improper functioning of the lower oesophageal sphincter. When this muscle relaxes at the wrong time, it allows stomach acid to back up into the oesophagus. This repeated exposure to acid can damage the lining of the oesophagus over time.^[3]

In achalasia, something damages the nerves that control the muscles in the oesophagus, but the exact cause remains unknown. Researchers believe it may be related to autoimmune processes, where the body’s immune system mistakenly attacks healthy tissue.^[1]

Eosinophilic oesophagitis is most commonly caused by allergy-induced inflammation. When a person with this condition is exposed to allergens, their immune system responds by sending large numbers of eosinophils to the oesophagus, causing inflammation and swelling.^[15]

Barrett’s oesophagus develops as a consequence of long-term, untreated GERD. The constant exposure to stomach acid causes the cells in the oesophageal lining to change their structure and function as an adaptive response.^[1]

Risk Factors

Several factors can increase your chances of developing an oesophageal disorder. Alcohol use is a known risk factor, as excessive alcohol consumption can irritate the oesophageal lining and weaken the lower oesophageal sphincter, making reflux more likely.^[1]

Carrying extra weight, whether due to obesity or pregnancy, puts additional pressure on the abdomen. This increased pressure can force stomach contents, including acid, back up into the oesophagus. Pregnant women often experience heartburn and reflux, particularly in the later stages of pregnancy when the growing baby puts more pressure on the stomach.^[1]

Certain medications can contribute to oesophageal problems. These include some antibiotics, antidepressants, and pain relievers. These medications may relax the lower oesophageal sphincter or directly irritate the oesophageal lining.^[1]

If you’ve had radiation therapy to your neck or chest area, such as for cancer treatment, you may be at higher risk for developing oesophageal disorders. Radiation can damage the tissues of the oesophagus, leading to inflammation, scarring, or strictures.^[1]

Smoking, including exposure to secondhand smoke, significantly increases the risk of several oesophageal disorders. Smoking can weaken the lower oesophageal sphincter, increase acid production, reduce saliva production (which normally helps neutralize acid), and increase the risk of oesophageal cancer.^[1]

Symptoms

The symptoms of oesophageal disorders vary depending on which condition you have, but some symptoms are common across many types. One of the most frequent symptoms is difficulty swallowing, called dysphagia. You might feel like food is stuck in your throat or chest, or you may have trouble starting the swallow. Some people experience pain when swallowing.^[1]

Heartburn is another very common symptom, particularly with GERD. This is a burning sensation in your chest that often occurs after eating and may be worse at night or when lying down. The pain can sometimes be so intense that it’s mistaken for heart problems.^[3]

Regurgitation means stomach acid or food comes back up from your stomach into your oesophagus and mouth. You might taste something sour or bitter, or you might actually bring up food you’ve recently eaten. This can be particularly bothersome at night when lying down.^[1]

Chest pain, back pain, or abdominal pain can occur with various oesophageal disorders. This pain isn’t always easy to distinguish from heart-related chest pain, so if you experience chest pain along with shortness of breath, or jaw or arm pain, you should seek immediate medical attention as these could be symptoms of a heart problem.^[3]

You might develop a chronic cough or sore throat if stomach acid repeatedly irritates your throat. Some people experience hoarseness or wheezing, and you may find yourself clearing your throat frequently. Indigestion, which is a burning feeling in your stomach, can also occur.^[1]

If you have nighttime acid reflux, you might experience an ongoing cough, inflammation of the vocal cords (laryngitis), or new or worsening asthma symptoms. These occur because acid can reach higher into the throat and airways during sleep.^[3]

Unexplained weight loss can be a concerning symptom, particularly if you’re having difficulty swallowing or if eating has become painful or uncomfortable. This might indicate a more serious condition that needs prompt medical attention.^[1]

Prevention

While not all oesophageal disorders can be prevented, there are several steps you can take to reduce your risk, particularly for GERD and related conditions. Making changes to your diet can have a significant impact. Certain foods are more likely to trigger reflux, including mint, fatty foods, spicy foods, tomatoes, onions, garlic, coffee, tea, chocolate, and alcohol. If you regularly eat these foods, try eliminating them to see if your symptoms improve, then add them back one at a time to identify your personal triggers.^[22]

How and when you eat is just as important as what you eat. Eating smaller meals more frequently throughout the day, rather than three large meals, can help prevent reflux. When your stomach is very full, there’s more chance of contents flowing back into the oesophagus. Try to finish eating at least three hours before bedtime, as lying down too soon after eating increases the risk of reflux.^[22]

Avoiding carbonated beverages can help because they make you burp, which sends acid into the oesophagus. Choose flat water instead of sparkling water or fizzy drinks.^[22]

Maintaining a healthy weight is important for preventing oesophageal disorders. Extra weight puts pressure on your abdomen, which can push stomach contents back up into the oesophagus. If you’re overweight, even losing a small amount of weight can help reduce symptoms.^[17]

Your sleeping position matters. When you sleep, try to keep your head elevated six to eight inches higher than your feet. You can achieve this by using extra-tall bed risers under the legs at the head of your bed. Gravity helps keep acid in your stomach when you’re elevated.^[22]

After eating, stay upright for at least three hours. Whether standing or sitting, gravity helps keep acid where it belongs. Avoid vigorous exercise for a couple of hours after eating, as bending over or strenuous activity can send acid into your oesophagus. A gentle after-dinner walk is fine, but save more intense workouts for later.^[22]

If you smoke, quitting is one of the most important steps you can take. Smoking weakens the lower oesophageal sphincter and increases your risk of multiple oesophageal disorders, including cancer. Even exposure to secondhand smoke can be harmful.^[1]

Limiting alcohol consumption can also help prevent oesophageal problems. Alcohol can irritate the oesophageal lining and relax the lower oesophageal sphincter, making reflux more likely.^[1]

How Oesophageal Disorders Change Normal Body Functions

To understand how oesophageal disorders affect the body, it helps to know how the oesophagus normally works. When you swallow, the upper oesophageal sphincter opens to let food enter from your throat. Almost immediately, within one to two seconds, the lower oesophageal sphincter also relaxes and opens. The food is then pushed down through the oesophagus by coordinated waves of muscle contractions. In normal peristalsis, one segment of muscle contracts while the segment below it relaxes, creating a wave that moves the food downward into the stomach.^[7]

In GERD, the lower oesophageal sphincter doesn’t close properly or opens when it shouldn’t. This allows stomach acid and digestive enzymes to flow backward into the oesophagus. The oesophageal lining isn’t designed to withstand acid exposure like the stomach lining is, so repeated contact with acid causes irritation and inflammation. Over time, this can lead to more serious changes in the tissue.^[3]

With achalasia, the problem is essentially the opposite. The lower oesophageal sphincter doesn’t relax or open properly when you swallow. Food and liquid collect above the sphincter, unable to pass into the stomach. The muscles of the oesophagus may also lose their ability to create coordinated contractions. This happens because the nerves controlling these muscles have been damaged.^[7]

In oesophageal spasms and other hypercontractile motility disorders, the muscles contract with excessive force or in an uncoordinated pattern. Instead of the smooth, wave-like progression of normal peristalsis, the muscles may contract simultaneously in different parts of the oesophagus, or with much more force than needed. This disrupts the normal movement of food and can cause significant pain.^[7]

When strictures develop, the oesophagus becomes narrowed, usually due to scarring from chronic inflammation or acid exposure. This narrowing physically obstructs the passage of food, particularly solid foods or large pieces. Liquids may pass through more easily than solids, depending on how narrow the stricture is.^[1]

In eosinophilic oesophagitis, inflammation caused by the accumulation of eosinophils makes the oesophageal wall thick and stiff. The normally flexible, stretchy oesophagus loses some of its ability to expand to accommodate food. The inflamed tissue is also more fragile and prone to tearing.^[1]