Disorders of the Esophagus
The esophagus is a mucus-lined, muscular tube that carries food from the mouth to the stomach. It begins at the base of the pharynx and ends about 4 cm below the diaphragm. Its ability to transport food and fluid is facilitated by two sphincters. The upper esophageal sphincter, also called the hypopharyngeal sphincter, is located at the junction of the pharynx and the esophagus. The lower esophageal sphincter, also called the gastroesophageal sphincter, is located at the junction of the esophagus and the stomach. An incompetent lower esophageal sphincter allows reflux (backward flow) of gastric con-tents. There is no serosal layer of the esophagus; therefore, if surgery is necessary, it is more difficult to perform suturing or anastomosis.
Dysphagia (difficulty swallowing) is the most common symptomof esophageal disease. This symptom may vary from an uncom-fortable feeling that a bolus of food is caught in the upper esoph-agus (before it eventually passes into the stomach) to acute pain on swallowing (odynophagia). Obstruction of food (solid and soft) and even liquids may occur anywhere along the esophagus. Often the patient can indicate that the problem is located in the upper, middle, or lower third of the esophagus.
There are many pathologic conditions of the esophagus, includ-ing motility disorders (achalasia, diffuse spasm), gastroesophageal reflux, hiatal hernias, diverticula, perforation, foreign bodies, chem-ical burns, benign tumors, and carcinoma.