Oesophagus Diseases
Why in News?
AstraZeneca–Amgen’s drug Tezspire (tezepelumab) met all primary and key secondary endpoints in a Phase III trial (CROSSING) for eosinophilic oesophagitis (EoE), showing significant improvement in swallowing and reduction in oesophageal inflammation.
Major Types of Esophageal Disorders
- GERD (Gastroesophageal Reflux Disease): The most prevalent disorder where the lower esophageal sphincter (LES) fails to close tightly, allowing stomach acid to surge upward, causing chronic heartburn and tissue damage.
- Eosinophilic Esophagitis (EoE): A rapidly increasing allergic/immune condition where white blood cells (eosinophils) build up in the esophagus, causing scarring, narrowing, and intense difficulty swallowing.
- Barrett’s Esophagus: A pre-cancerous state triggered by long-term untreated acid reflux, where the normal lining of the esophagus mutates into tissue resembling the intestinal lining.
- Achalasia: A rare motility disorder where the lower esophageal muscle fails to relax, trapping food inside the esophagus instead of letting it pass into the stomach.
- Esophageal Cancer: Divided primarily into Squamous Cell Carcinoma (linked to smoking/alcohol) and Adenocarcinoma (linked directly to Barrett's esophagus and obesity).
Key Symptoms to Watch For
- Dysphagia: Sudden or progressive difficulty swallowing food, or the sensation that food is actively stuck in the chest.
- Odynophagia: Experiencing sharp pain while trying to swallow.
- Acid Regurgitation: Acid or undigested food spontaneously bubbling up into the throat or mouth, leaving a bitter, metallic taste.
- Non-Cardiac Chest Pain: Burning chest pain mimicking a heart attack, often worsening when lying flat after eating.
- Atypical Symptoms: Chronic dry cough, voice hoarseness, night-time wheezing, or unexplained weight loss.
Primary Risk Factors
- Lifestyle Habits: Chronic smoking, heavy alcohol use, and drinking exceptionally hot beverages.
- Obesity: Increased abdominal pressure physically forces stomach acid past the sphincter into the esophagus.
- Pill Overuse: Taking common medications (like NSAIDs, iron supplements, or bisphosphonates) with inadequate water or right before sleeping can cause local chemical ulcers (pill esophagitis).
- Untreated Allergies: Underlying food or environmental allergies trigger systemic inflammation fuelling EoE.
Modern Treatment Options
- Lifestyle Modifications: Eating smaller meals, remaining upright for at least 3 hours post-dinner, losing weight, and avoiding triggers (citrus, alcohol, spicy food).
- Pharmacology: Standard usage of Proton Pump Inhibitors (PPIs) and H2 blockers. Newer Potassium-Competitive Acid Blockers (P-CABs like Tegoprazan) have recently demonstrated the ability to heal severe tissue erosion in just 2 weeks.
- Biologics: Targeted immune therapies like Dupilumab and the newly successful Tezspire block the specific allergy pathways causing EoE.
- Surgical & Endoscopic Fixes: Less-invasive procedures like Transoral Incisionless Fundoplication (cTIF) or surgical Nissen fundoplication to physically tighten a weak stomach valve.
