esophagus health

Esophagus Diseases

Basics of anatomy and physiology

The esophagus is a hollow tube-shaped organ (25-30 cm long) that connects the pharynx to the stomach; the esophagus is limited superiorly by the upper esophageal sphincter (or cricopharyngeal) and inferiorly by the inferior esophageal sphincter (or cardia).

From the histological point of view, the esophagus is made up of 4-5 layers; proceeding from the inside (lumen) to the outside, in order are: mucosa, submucosa, muscular, adventitious and serous (present only in the portion closest to the stomach).

NB . The esophagus is an organ involved in swallowing, a process useful for transporting the food bolus from the mouth to the stomach; this movement starts voluntarily (tongue, glottis, etc.) and then turns into an involuntary movement. This means that the upper portion of the esophagus has a striated musculature that contracts by the will of the subject (such as that of the musculoskeletal system, for instance), while the lower esophageal tract is characterized by a smooth musculature (such as that of the stomach and the 'intestine), therefore involuntary.

Insights: the mechanism of the DEGLUTION

Swallowing is based on synchrony and coordination between the larynx, pharynx and esophagus, and takes place in 3 distinct phases:

  1. Oral, voluntary phase, the bolus is pushed by the tongue into the backbore.
  2. Pharyngeal phase, involuntary and reflex, consists in the passage of food in the esophagus through the pharynx; in this phase the epiglottis is dislocated posteriorly and prevents the passage of the bolus in the respiratory tract.
  3. Esophageal phase, involuntary, favors the transit of the bolus up to the stomach thanks to the esophageal peristalsis ("wave" movement that squeezes the esophagus from the top downwards). There are two types of esophageal peristalsis: primary or triggered by swallowing and secondary or generated by esophageal distension).

Illnesses

It is possible to affirm that the diseases of the esophagus are secondary to an altered motility of the whole organ. Specifically, esophageal diseases can be classified into:

  1. Hypermotility diseases, in other words determined by an increased contractile capacity of the esophagus
  2. Hypomotility diseases, that is determined by a lower contractile capacity of the esophagus.

Hypermotility diseases

These disorders are characterized by: the presence of muscular contractions of the alimentary bolus advance (peristaltic waves) violent and / or not coordinated with each other, and by the inability to release the esophageal sphincter.

Achalasia : a disease that affects the failure to release the lower esophageal sphincter associated with an absent or incoordinated movement of the esophagus. It is frequently caused by the depletion of neurons inhibiting muscle tone and the most indicative symptom is DYSFIA, or the sensation of stopping the bolus "behind the sternum". It is a kind of dysphagia called paradox as it involves both the ingestion of liquids and solids, and therefore it differs from progressive dysphagia which mainly affects liquids; it is frequently accompanied by the regurgitation of food material. The diagnosis is made through the manometry that measures both the absence of esophageal muscular movement and the increase in the pressure of the lower esophageal sphincter. The therapies are different: pharmacological (by injection), endoscopic dilatation of the sphincter and surgery.

Nutcracker esophagus and corkscrew esophagus : the nutcracker esophagus disease determines normally coordinated contractions but with amplitude and average duration exceeding the norm, which are strongly felt painfully. The corkscrew esfago (or widespread esophageal spasm) is characterized by numerous uncoordinated non-peristaltic contractions (simultaneous, therefore not propulsive), which occur after swallowing with angina-like pain. These are diseases of the esophagus associated with psycho-physical stress conditions, which can be diagnosed by means of a manometer and pharmacologically cured.

Esophageal diverticula : may be genetic or acquired. Those acquired can be caused by a gradual exfoliation of the mucosa and submucosa as an effect of increased pressure (known as acquired) or due to scar retraction on the wall of the esophagus (called "traction").

Hypo-mobility disorders

They are diseases of the esophagus characterized by constricting ineffectiveness concerning the lower esophageal sphincter; the main clinical manifestation is gastro-oesophageal reflux (GERD).

Gastro-oesophageal reflux disease (GERD) : a generally asymptomatic esophagus disease which in the long term can compromise the integrity of the mucosa; GERD determines: burning (heartburn) localized in the retrosternal area (due to the acid action of the gastric contents on the mucous membrane of the esophagus), the regurgitation of acid material and epigastric pain (felt just below the sternum). The exams to diagnose GERD are mainly the esophagogastroduodenoscopy and the 24hmetry. The cure consists mainly of drug therapy and diet therapy.

If neglected, GERD can get complicated and cause esophagitis or worse, Barrett's esophagus.

NB . It was decided NOT to treat the "tumors of the esophagus" as it is already extensively described together with the relative chapter entitled "Drugs to treat esophageal cancer" which can be found on our website.

CONTINUE: Nutrition for diseases of the esophagus ยป

Bibliography:

  • Gastrenterology manual for dietitians - National Coordination of University Teachers of Gastroenterology - Italian Gastroenterology Publishing - pag 48:50