Side Effects of Esophageal Cancer

On-going issues with acid reflux, or Gastro-Esophageal Reflux Disease (GERD), is a common side-effect for patients and survivors. Despite a new anatomy that repositions your stomach, the amount and strength of reflux may be different and often times more than the reflux experienced before treatment .

Similar to before treatment there are a variety of ways to limit GERD.

Most people with GERD, especially those who had EC surgery, should take certain measures to enjoy a full night sleep without disruption.

• Do not eat any food or drink 3 hours before bed
• Add a wedge underneath your bed or mattress to sleep on an angle
• Limit your amount of spicy food or alcohol

If you are experiencing trouble sleeping, you should also take note of other Common Issues and understand the Importance of Nutrition.

“Dumping syndrome” is the name given to a range of symptoms that can develop after gastric surgery . The symptoms are varied in both in number and severity, and in most patients they lessen over time.

Normally, food that enters the stomach remains there for some period of time and is broken down, or digested, before being passed into the small intestine where nutrients are then absorbed into the bloodstream. Surgery on the stomach often results in the removal or restricted functioning of this controlled entry and exit of food through the stomach.

Without this control, partially or fully undigested food moves rapidly, or is “dumped,” into the small intestine . The undigested food draws water from the body directly into the intestine to continue the digestive process. This rush of fluid from the body is the main cause of symptoms related to dumping syndrome.

There are two types of dumping syndrome – quick onset and late onset. With quick onset, the symptoms appear very soon after eating; typically within 15 minutes. With late onset, symptoms occur from 1-3 hours after eating

The symptoms of dumping syndrome are also as varied as the population. People can experience no symptoms at all, some symptoms, or all of them. The extent of the symptoms also varies widely, from mild discomfort to incapacitating .

In quick onset dumping syndrome, the following symptoms can occur:

• Nausea
• Vomiting
• Abdominal cramping
• Diarrhea (Sometimes explosive)
• Dizziness
• Belching and bloating
• Fatigue
• Racing heart rate

In late onset dumping syndrome, the following symptoms can occur:

• Sweating
• Fatigue
• Dizziness
• Trembling
• Anxiety
• Racing heart rate
• Fainting
• Confusion
• Diarrhea (Sometimes explosive)

Esophageal dilatation is the technique used to stretch or open the blocked portion of the esophagus.

CAUSES

There are several causes of blockage or stricture of the esophagus . They all can make swallowing food and/or fluids difficult. The physician’s first job is to find the reason for the stricture or narrowing. The answer can usually be provided by the medical history, physical exam, x-rays, and endoscopy which is a visual exam of the esophagus using a flexible fiberoptic tube.

Acid Peptic Stricture – This condition is very common. The stomach produces acid which, in turn, can reflux into the esophagus. This event is usually made worse by the presence of a hiatus hernia. 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.

Schatzki’s Ring – This condition is really exactly that, a narrow ring of benign fibrous tissue constricting the lower esophagus. Physicians still do not know how it develops.
Achalasia – This condition is uncommon and quite fascinating to physicians. The problem is a persistent and marked spasm of the lower esophageal muscle. This spasm just does not open up to allow food and fluid through. The result is a persistent blockage with subsequent slow trickling of the esophageal contents into the stomach .

Ingestion of Caustic Agents – Children are particularly prone to swallowing liquid lye and other agents which can severely burn the esophagus, leaving it narrowed.

Tumors – Various forms of tumors, benign and malignant, can block the esophagus. This condition is obviously very important to diagnose and treat promptly.

Heredity – The esophagus may be partially or completely blocked at birth.

TREATMENT

In most instances, the problem is a mechanical one with an obstruction acting like a dam across a stream. Therefore, the treatment must be mechanical. The dam must be broken. After a diagnosis is made, the physician determines the best method of treatment. The physician has a variety of techniques available. Each has benefits and is appropriate in specific cases. The physician will always discuss these options with the patient.

Simple dilators (Bougies) – These are a series of flexible dilators of increasing thickness. One or more of these are passed down through the esophagus at a time . The bougie is the simplest and quickest method of opening the esophagus.

Guided Wire Bougie – In some instances, the physican performs endoscopy and places a flexible wire across the stricture. The endoscope is removed and the wire left in place. A dilator with a hole through it from end to end is guided down the esophagus and across the stricture. One or more of these dilators are passed over the wire. At the end of the exam, the wire is removed. This type of treatment may be performed in the x-ray department under fluoroscopy .

Balloon dilators -Flexible endoscopy allows the physician to directly view the stricture. Deflated balloons are placed through the endoscope and across the stricture. When inflated, they become sausage shaped, stretch, and break the stricture.

Achalasia Dilators – Achalasia is a special situation which requires a larger, balloon-type dilator. The procedure is frequently done under x-ray control. In this situation, the spastic muscle fibers in the lower esophagus are stretched and broken, which in turn allows easier passage of food and liquid into the stomach .