Chest pain after Esophagectomy

[rockman4417]

Hey guys! So I had an Esophagectomy over 20 years ago when I was just a kid. I'm now 28 and I have had fairly few complications aside from GERD. Until about 6 months ago that is. Certain heavy foods get stuck at the base of the gastric tube, unwilling to pass into the stomach. This is accompanied by soreness in the chest, just behind the breastbone that lasts for a few days following an episode. Eating becomes increasingly painful until the soreness goes away.

I have read the gastric tube tends to narrow over time, and I have never had it dilated. Obviously I need to get to the GE to figure out for sure what's going on. But I'm wondering if gastric tube cancer has ever been found in an Esophagectomy patient who did NOT have esophageal cancer? I'm just wondering if GERD can eventually cause cancer in the gastric tube itself.

[Hidden]

I think your situation is an unusual one. There are people around who had an oesophagectomy 20+ years ago but predominantly they are older people, so their experience may not help you much.

The clue to this may be in your words about 'heavy foods'. Perhaps your system is becoming overloaded and is remaining in your new stomach in the area of your chest cavity, and perhaps distorting the natural shape of the tube so that food does not drain out from the bottom of it? I think that going for a barium swallow test would indicate whether or not this is happening and whether there is some kind of blockage equivalent to a lower oesophageal sphincter being too tight (except that you presumably do not have a LOS but I am trying to envisage what might be happening! Much like your description of the gastric tube narrowing). There might be a possibility of the pyloric sphincter at the base of the stomach needing dilatation and this is common for those who have had an oesophagectomy recently. I am sure that the shape of your 'new stomach' will have changed over the years. Or there may be some kind of 'pouch' that has developed.

So meanwhile if you eat little and often and avoid food that might be heavy (eg some kinds of bread , rice or others that might congeal) it might give you a clue about what causes you trouble? If the food is hanging around, the effect of, say, spicy food (or medication) might be more intense because of not passing though the system? Do you suffer from nausea at all (an indication of food not clearing from your stomach)?

I have not heard of cancer developing for a patient who did not originally have cancer as you speculate. As I understand it, depending on details of the surgery, the remainder of the oesophagus will still be subject to damage from acid reflux and the development of Barrett's Oesophagus, but this would certainly be far reduced because it would be likely that the patient would be on acid-suppressant medication like a PPI. GORD / GERD is very predominantly an issue for the potential of oesophageal adenocarcinoma rather than gastric cancer, but it is also true that if you have symptoms that persist you need to get them checked out.

The chances of your problem being cancer are just as low as for anybody else and I doubt that the oesophagectomy is relevant in this respect. I do believe that the surgeons will take great care of you and will be interested in what you are experiencing but you do need to have this one checked out.

[strangetimes]

Obviously I don't know the details of your medical history but I imagine that something quite unusual must have been going on for you to have an esophagectomy at such a very young age .

What crosses my mind is that with an esophagectomy the stomach is used to form a new oesophageous ,and I'm wondering if , as the stomach is designed to cope with stomach acid in a way that the oesphagous isn't ,that your new gastric tube will actually be more resistant to acid ?

But yes a trip to GP and referral will give more answers . Maybe a dilation needed ?

[rockman4417]

First of all thank you both for the detailed replies! I do indeed have a very complicated history of gastric problems.

It all started when I was two years old, when my mom came home to find my step-dad pouring drain cleaner down my throat(his reason for doing this I will never know). But the chemical rendered the function of my esophagus useless. I spent a lot of time on the feeding tube until I got the esophagectomy. And by the time all the numerous surgeries were done my child self was just sick of being in the hospital and ready to try and be a normal kid again.

Once I had enough dilations and check-ups to get my swallowing to a somewhat normal function, my family never took me back to the GI and I guess my mind sort of pretended that all that stuff never happened. Plus I was a dirt poor college student in my early 20s, like most at that age, I gave my health the last priority.

Up until two years ago, all I needed to treat my GERD was a bit of apple cider vinegar before bed. Now all it does is make things worse. The only thing that prevents sever throat burning while I sleep is Gaviscon. Incidentally my swallowing problems arose shortly after the GERD flared up. However I have no nausea at all, but have noticed worsening shortness of breath. When I do eat heavy foods, it can get stuck upon the very first bite if it's big enough. The prime symptom for esophageal cancer, except I have no esophagus! The LES is what I use to swallow with now. And I have been told the gastric tube is more resistant than the esophagus is to acid erosion. Maybe that's why I've made it all these years without a problem!

So I called a few GIs today and set up an appointment for Monday. I will probably tell him everything I told you guys and be referred for a Barium swallow. I'm just happy to finally talk to people who understand what I'm going through! Everyone else who hears I don't have an LES they just give me blank stares. It's amazing how we take something like normal eating for granted.

[drsteve in reply to rockman4417]

Hello,

I have had an esophagectomy as well (for Achalasia). There are several things to consider. You must have not only a barium swallow, but an EGD (endoscopy). The anastamosis site (site where the remaining piece of esophagus was joined to your stomach - if you had a gastic pull up). You may need a dilation. The EGD will check the quality of your mucosa (the lining of the tube) to see if there are any changes to the tissue. The chest pain may be due to many different things.

Please see my book (free download) at livingwithachalasia.org. There is a wealth of information in it.

Best to you,

Dr. Steve

[chris_usa]

I think the main area of risk for developing a cancer in a situation like yours would be in the small amount of esophagus that remains. There had to be some esophagus left so as to attach the pulled-up stomach to. In my case the doc said that there was 3-4 cm of esophagus remaining after my total esophagectomy five years ago (transhiatal approach). This remaining tissue is sensitive to acid (GERD), and likely had a rough time from the original caustic exposure.

The main risk factor for adenocarcinoma of the esophagus is repeated damage, such as from acid. I don't know if you take PPIs or other medicine to decrease acid.

I think your overall risk is low for a cancer at this point, but it is slightly possible. I think acid reducing medications would lower your risk. It sounds like there is a narrowing at the site where your stomach was attached, and this is possibly from acid exposure. However, it could also be scar tissue that can increase over time.

The steps you are taking sound reasonable, and I think you should take steps to lessen your risk. But I think that if you have made it 20 years so far, you are good for another 20. Best of luck. \wc