Disorders of Esophagus

The GI tract is a long tube with one entrance (the mouth) and one exit (the anus), and problems can occur in any section on the way down. The esophagus is the part of the tube between the mouth and the stomach. The muscles of the esophagus contract and relax to propel food down. A muscular valve at the base of the esophagus closes off the stomach so that its acidic contents can't leak back up into the esophagus.

Heartburn - a burning sensation behind the center of the ribcage - occurs when stomach contents travel back up the esophagus. If you experience heartburn, it usually happens thirty to sixty minutes after eating and is sometimes accompanied by a sour taste in the mouth. Heartburn can be prevented by waiting at least three hours after meals to lie down, by elevating the head of the bed or using extra pillows in bed, and by avoiding spicy or acidic foods. Other lifestyle changes to help prevent heartburn include maintaining a healthy weight and avoiding tight belts or pants.

Frequent heartburn is a side effect of some HIV medications. It may also be a sign of esophageal reflux disease, called GERD for short. GERD can damage the lining of the esophagus and lead to other complications. Frequent heartburn should be discussed with your health care provider, as inexpensive, over-the-counter treatments are available. Further testing by your provider, including looking down the esophagus with a camera (an upper endoscopy), may be necessary if the symptoms don't go away.

Another symptom related to the esophagus is pain when swallowing or difficulty swallowing. Those symptoms should raise a red flag, especially for people with low immune function (CD4 counts less than 200), as they may be signs of a yeast infection (esophageal candidiasis), cytomegalovirus (CMV), or herpes virus (HSV), each of which requires specific therapy. Left untreated, swallowing problems can have a significant negative impact on medication adherence, nutrition, and, of course, quality of life. Treating AIDS with highly active antiretroviral therapy (HAART) helps to cure esophageal infection and to prevent future infections.

Several medications -- some used to treat HIV and opportunistic infections as well as some used to treat other illnesses and conditions -- may cause direct injury to the lining of the esophagus if the pills get stuck in the esophagus as they travel down. They should always be taken with plenty of water while you're sitting up to make sure that the medications are appropriately washed down.