Pancreatobiliary Diseases

(Disorders of the pancreas, gall bladder and bile ducts)

• Gallbladder disease — the gallbladder is a sac (located near the liver) that stores bile produced in the liver. Conditions that slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease, such as:

  • Gallstones (cholelithiasis)

  • Inflammation of the gallbladder (cholecystitis)

  • Infection

  • Obstruction

• Pancreas disease — the pancreas produces and releases insulin and glucagon into the bloodstream to keep blood sugar levels within a normal range. The pancreas also produces enzymes to aid in the digestion of fats, proteins and carbohydrates in the intestine. Disease of the pancreas include:

  • Pancreatitis (acute and chronic inflammation of the pancreas)

  • Solid tumors (malignant and non-malignant)

  • Cystic tumors (may be benign, pre-malignant or malignant)

  • Pseudocysts (a fluid collection of pancreatic enzymes)

  • Strictures (blockages)

• Bile duct disease — bile ducts carry bile from the liver to the intestine, where it aids in the digestion of food. Bile duct diseases include:

  • Stones (choledocholithiasis)

  • Strictures (narrowing of a duct that prevents bile from draining)

  • Tumors (malignant and non-malignant)

  • Cysts

  • Cholangitis, an infection of the bile ducts

Esophagus Disease

• Gastroesophageal Reflux Disease (GERD) — occurs when stomach acid backs up into the esophagus, causing a burning sensation (also called acid reflux disease). Symptoms typically occur two or more days a week for at least three months. GERD occurs because the valve separating the esophagus and stomach does not close properly. About 30 million Americans suffer daily from GERD. People with chronic acid reflux may experience a variety of symptoms including heartburn, regurgitation of food, swallowing difficulties, excessive belching, hoarseness, sore throat, frequent throat clearing, non-cardiac chest pain, chronic cough, sleeping problems, sinusitis or breathing problems such as shortness of breath or wheezing. The complications of GERD can extend beyond the esophagus. GERD can damage the lining of the esophagus, resulting in a narrowing (stricture) of the esophagus. This can affect the functioning of the esophagus. GERD can also lead to Barrett’s esophagus, a condition that alters the cells in the lining of the esophagus.

• Barrett’s Esophagus — develops in some people who have chronic GERD or inflammation of the esophagus (esophagitis). In Barrett’s esophagus, the normal (squamous) cells that line the esophagus turn into a type of cell called specialized columnar cells. Damage to the lining of the esophagus (by acid reflux) causes these abnormal changes. Once the cells have turned into columnar cells, they will not revert back to normal. Up to 1 percent of people with Barrett’s esophagus develop esophageal cancer.

• Dysphagia — difficulty in swallowing affects about one out of every 17 persons. The causes of dysphagia vary widely, and include:

  • Lack of coordination of the esophageal muscular contractions

  • Chronic heartburn, where the esophagus is damaged by excessive reflux of acid-containing stomach contents

  • Tumors

  • Central nervous system disorders such as stroke, multiple sclerosis and Parkinson’s disease

  • Scar tissue or narrowing in the esophagus

  • Pouches (diverticula) that protrude through the lining of the throat and esophagus

  • Radiation or operative injury

  • Drug-induced injury

  • Infections

• Gastroesophageal motility disorders — weak or uncoordinated muscular contractions of the esophagus, interfering with the movement of food or fluid from the throat to the stomach. One such motility disorder is diffuse esophageal spasm, uncoordinated contractions of the esophagus that affect the movement of food to the stomach. It can cause difficulty swallowing, regurgitation and chest pain.

• Achalasia (“failure to relax”) — a disorder in which the esophagus is less able to move food toward the stomach, and the muscle from the esophagus to the stomach does not relax as much as it needs to during swallowing. As a result, people have difficulty swallowing food.

• Diffuse esophageal spasm — irregular contractions of the muscles in the esophagus; the spasms do not move food effectively to the stomach.

• Eosinophilic esophagitis — an inflammatory condition in which the wall of the esophagus becomes filled with large numbers of eosinophils (white blood cells produced in bone marrow that actively promote inflammation, particularly inflammation caused by allergic reactions). The most common cause of eosinophilic esophagitis is acid reflux.