Hiatal Hernia with Ulcers
This is a 46 year old man came to our office complaining of trouble swallowing solid food for the past two months. He also has had chronic heartburn for over eight years, but never told his doctor. He buys TUMS in the large enconomy size and must take them almost every day. When his wife noticed him choking at meals, she insisted he see the doctor. This short video segment was taken at his gastroscopy examination.
Normally the opening between the esophagus and stomach acts like a one-way valve. This is called the Lower Esophageal Sphincter, or LES. It only opens when you swallow. Otherwise it is always tightly closed which prevents stomach acid from backsplashing up into your esophagus. This video shows that this patient's LES is always wide open - exposing his esophagus to acid injury. The dark circular area is the open valve between the esophagus and stomach. Above the open valve, you can clearly see four dark red inflammed ulcers where the acid has splashed upward and eaten into his esophagus. This condition is often called Gastroesophageal Reflux Disease, or GERD.
Difficulty swallowing is one of the seven warning signs of cancer. But, this patient's symptoms were not due to cancer, but the ulcers and scar tissue from years of heartburn. He was given a prescription for Prevacid and was asked to return after eight weeks of treatment to rescope him. This allows the doctor to be sure the ulcers have healed completely and that there are no underlying changes of Barrett's esophagus.
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