Esophageal Dilatation
By Philip Clements, M.D., M.P.H., UCLA School of Medicine,
Dept. of Rheumatology (originally published in "Scleroderma
Voice," 2002 #3)
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Philip
Clements , M.D., M.P.H. |
Question: What can you tell me about "throat-stretching"?
Answer: Actually
the stretching occurs lower in the chest than in the throat.
Generally the narrowing is at the end of the esophagus (the
feeding tube that leads to the stomach) just before the esophagus
joins the stomach. The reason that the narrowing (stricture
or scarring) occurs is that the muscle that normally closes
the esophagus from the stomach gets weak, and the opening
between the esophagus and stomach remains open much too long
a time. This allows hydrochloric acid acid (which is
a very strong acid) and stomach juices to reflux (or back
up) into the esophagus and actually "burn" the esophagus,
much as strong acid might burn any tissue. As a result, there
may be a scar that forms at the end of the esophagus.
Esophageal dilatation (or stretching) is the correct term
for the procedure. A tube is passed through the mouth and
down the esophagus, and actually stretches the narrowing at
the end of the esophagus. This allows food to go down more
easily.
Unfortunately, dilating the opening can also then allow stomach
contents to reflux back into the esophagus. Nexium® and
other proton-pump inhibitors (Prevacid®, Prilosec®,
Protonix®, and Aciphex®) are very good at decreasing
the amount of acid in the stomach juice. When stomach juice
refluxes into the esophagus the juice is no longer acidic
and, therefore, is much less likely to burn or scar the esophagus. |
