The esophagus is the tube that carries food and liquids from the mouth into the stomach. The wall of the esophagus is composted of layers of muscle that propel food to the stomach by rhythmic waves of contractions called peristalsis. There are muscles rings at each end of the esophagus, – called sphincters. These sphincters open to allow food to move forward and then close to prevent food and acid from moving backwards, helping prevent acid reflux and aspiration, or choking.
Upon swallowing, the upper esophageal sphincter opens and the esophageal muscles contract to push food downward. The lower esophageal sphincter opens temporarily to allow food to pass into the stomach. Then the sphincter closes to prevent food and stomach acid from flowing backward up the esophagus.
Primary esophageal diseases and disorders
GERD, Barrett’s Esophagus, Esophageal Cancer and Hiatal Hernia
Gastroesophageal reflux disease (GERD) is a common chronic disease where the acid from the stomach comes back up into the esophagus. The anatomical barriers that keep stomach acid from flowing upward are the lower esophageal sphincter and the diaphragm. Symptoms include heartburn ( acid indigestion), chest pain, regurgitation and hoarseness.
A Hiatal Hernia is an opening of the diaphragm that allows part of the stomach to slide into the chest. A hiatal hernia can contribute to or worsen symptoms of GERD. A hiatal hernia can be seen on an endoscopy, X-rays, and CT scans among other studies.
When GERD constantly irritates the esophagus, it can damage the lining of the esophagus and result in Barrett’s esophagus, a precancerous condition. About 8% of people with GERD go on to develop Barrett’s esophagus.
Esophageal cancer accounts for 3% of cancer deaths in the U.S. Symptoms of esophageal cancer include difficulty swallowing, painful swallowing, chest pain, worsening GERD, cough, or weight loss. Risk factors include GERD, Barrett’s esophagus, obesity, smoking, and alcohol consumption. There are two primary types of esophageal cancer –adenocarcinoma or squamous cell carcinoma. Squamous cell carcinoma involves the upper and mid esophagus and is the most common esophageal cancer worldwide. Adenocarcinoma involves the lower esophagus and is the most common type in the United States.
Achalasia is a rare disease of the esophagus where people have difficulty swallowing because the muscles of the esophagus fail to relax and allow food to pass into the stomach. It is believed to be caused by a malfunction of the nerves in the esophagus.
Both GERD and Achalasia are related to a malfunction of the esophageal sphincters.
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