Esophagus Disorders

Esophagus Disorders

The esophagus is the tube that carries food, liquids and saliva from your mouth to the stomach. You may not be aware of your esophagus until you swallow something too large, too hot or too cold. You may also become aware of it when something is wrong.

The most common problem with the esophagus is gastroesophageal reflux disease (GERD). It happens when a band of muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux into, into the esophagus and irritate it. Over time, GERD can cause damage to the esophagus. Other problems include heartburn and cancer.

Treatment depends on the problem. Some get better with over-the-counter medicines or changes in diet. Others may need prescription medicines or surgery.

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. The walls of the esophagus propel food to the stomach not by gravity, but by rhythmic waves of muscular contractions called peristalsis.

How the Esophagus Works As a person swallows, food moves from the mouth to the throat, also called the pharynx (1). The upper esophageal sphincter opens (2) so that food can enter the esophagus, where waves of muscular contractions, called peristalsis, propel the food downward (3). The food then passes through the lower esophageal sphincter (4) and moves into the stomach (5).

Just below the junction of the throat and the esophagus is a band of muscle called the upper esophageal sphincter. Slightly above the junction of the esophagus and the stomach is another band of muscle called the lower esophageal sphincter. When the esophagus is not in use, these sphincters contract so that food and stomach acid do not flow up from the stomach to the mouth. During swallowing, the sphincters relax so food can pass to the stomach.

With aging, the strength of esophageal contractions and the tension in the sphincters decrease. This condition, called presbyesophagus, makes older people more prone to backflow of acid from the stomach (gastroesophageal reflux or GERD—see Peptic Disorders: Gastroesophageal Reflux (GERD)), especially when lying down after eating.

Two of the most common symptoms of esophageal disorders are dysphagia (an awareness of swallowing difficulty) and chest or back pain. Dysphagia and chest or back pain may occur in any esophageal disorder, the most serious of which is esophageal cancer.

How the Esophagus Works

Esophageal Varices

The esophageal disorders discussed in this chapter are propulsion-related, infection-related, injury-related, or obstruction-related. In another esophageal disorder, called esophageal varices, the veins at the lower end of the esophagus become dilated and bleed easily (see Gastrointestinal Emergencies: Abdominal Abscesses and Manifestations of Liver Disease: Portal Hypertension).