Section 9. Digestive Disorders

Chapter 120. Disorders of the Esophagus

Topics: Introduction | Obstruction of the Esophagus | Abnormal Propulsion of Food | Injury to the Esophagus

Introduction

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.

See the figure How the Esophagus Works.

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 age, 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), especially when lying down after eating.

Two of the most common symptoms of esophageal disorders are dysphagia (an awareness of difficulty in swallowing) 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.

The esophageal disorders discussed in this chapter are obstruction-related, propulsion-related, or injury-related. In another esophageal disorder, called esophageal varices, the veins at the lower end of the esophagus become dilated and twisted and bleed easily (see Section 9, Chapter 132 and Section 10, Chapter 135).