Patulous Esophagus

Patulous esophagus is a condition where the esophagus, the tube that carries food from the mouth to the stomach, remains abnormally open. This finding is often detected during radiological imaging, particularly on barium swallow studies or CT scans.

A patulous esophagus can be associated with various conditions, including gastroesophageal reflux disease (GERD), esophageal motility disorders, connective tissues disorders, neuromuscular disorders and aging to name some.

Imaging Findings of a Patulous Esophagus

Radiologists can identify a patulous esophagus using different imaging techniques. The most common methods include:

• Barium Swallow Study: This fluoroscopic study involves the patient swallowing a contrast material (barium), which helps highlight the esophagus’s shape and function. A patulous esophagus may appear dilated, with decreased peristalsis (the movement that pushes food downward).
• Computed Tomography (CT) Scan: On a CT scan, a patulous esophagus may appear as an abnormally widened esophageal lumen, sometimes filled with air or fluid.
• Endoscopy: Though not an imaging modality, endoscopy may be used to directly visualize the esophageal lining and confirm the diagnosis when radiologic findings suggest abnormal dilation.

Causes and Associated Conditions

A patulous esophagus can be a primary or secondary finding linked to underlying conditions. Some of the common causes include:

• Gastroesophageal Reflux Disease (GERD): Chronic acid reflux can weaken the esophageal walls, leading to dilation.
• Scleroderma: This autoimmune disease affects connective tissues, including the esophagus, reducing motility and causing dilation.
• Neurological Disorders: Conditions like Parkinson’s disease and multiple sclerosis may impact esophageal function, leading to widening.
• Chronic Vomiting: Repeated strain on the esophagus from vomiting can cause it to become patulous over time.
• Aging and Muscle Weakness: In older adults, the esophageal muscles may naturally weaken, leading to dilation without an underlying disease.

Symptoms and Clinical Significance

Many people with a patulous esophagus do not experience noticeable symptoms. However, when symptoms occur, they may include:

• Difficulty swallowing (dysphagia)
• Regurgitation of food or liquids
• Chronic cough
• Heartburn or chest discomfort

When to Seek Medical Attention

If a radiology report mentions a patulous esophagus, it is important to discuss the findings with a doctor. While some cases are harmless, others may indicate an underlying medical condition requiring further evaluation. A gastroenterologist may recommend additional tests, such as esophageal manometry, to assess muscle function.

Treatment and Management

The treatment of a patulous esophagus depends on the underlying cause. Some potential management strategies include:

• Lifestyle Modifications: Avoiding large meals, staying upright after eating, and elevating the head while sleeping can reduce symptoms.
• Medications: Proton pump inhibitors (PPIs) or H2 blockers can help manage acid reflux that may contribute to esophageal dilation
• Surgical Options: In severe cases, surgical interventions like esophageal tightening procedures may be considered.

Radiologist’s Perspective

In my practice, I frequently encounter a patulous esophagus on CT scans, especially in older adults and patients with chronic reflux. While the finding itself is often incidental, it can be a clue to an undiagnosed motility disorder or underlying systemic disease. When I see a markedly dilated esophagus with food or fluid retention, I recommend further evaluation by a gastroenterologist.

Conclusion

A patulous esophagus is a radiologic finding that can indicate an underlying condition or simply be a benign variant. If identified on imaging, discussing the finding with your doctor is important to determine whether further evaluation is needed. By understanding its causes, symptoms, and imaging characteristics, patients can take proactive steps to manage their health effectively.

References

1. https://my.clevelandclinic.org/health/diseases/16976-esophageal-disorders
2. https://www.sciencedirect.com/science/article/abs/pii/S0049017216000603
3. https://www.medicalnewstoday.com/articles/219314#treatment