The oesophagus (or gullet) is the tube that connects the mouth to the stomach. Diseases affecting the oesophagus typically cause symptoms such as heartburn, indigestion and difficulty swallowing. These symptoms are frequently aggravated by eating and lying flat. The most common cause for these symptoms is acid coming into the oesophagus. This is often due to weakness of the valve between the oesophagus and stomach. These symptoms can be treated with simple antacids that neutralise the acid. If the symptoms persist, stronger medications can be used. These stronger medications can reduce the amount of acid that the stomach produces.
Most people with oesophageal symptoms do not require specialist assessment. Specialist referral can be beneficial for patients with severe or worrying symptoms. Patients can have their symptoms reviewed and be examined. They may then benefit from a flexible camera examination of the oesophagus to look for evidence of acid damage or scarring. The camera examination of the oesophagus – an endoscopy- is performed as a day-case procedure. Patients can be offered sedation so that they are drowsy during the procedure. A diagnosis can often be made immediately after the endoscopy and treatment commenced.
After camera assessment, the majority of patients’ symptoms respond well to lifestyle changes and medication. Some patients have symptoms that persist despite medical treatment, do not wish to take regular medication or develop side-effects from antacid treatment. These patients benefit from special oesophageal studies that measure the strength of the valve at the bottom of the oesophagus (gullet) and establish if their symptoms correlate with acid in the gullet – oesophageal manometry and pH studies. This is performed as an out-patient. A fine tube is passed into the nose and then down the gullet. The strength of the valve is then assessed. Once this has been performed a probe may be left overnight in the gullet. This is to establish if the symptoms correlate with acid in the oesophagus.
If the valve between the oesophagus (gullet) and stomach is weak and symptoms are typical for reflux, these patients can be considered for an operation. This operation is performed routinely as ‘key-hole’ surgery and is very effective for appropriately selected patients.