What is the esophagus?
Muscular tube that conveys food from pharynx to stomach
Muscle layers of the esophagus? 2
What is it missing?
Food passes through quickly because of what?
1. Inner circular muscle
2. Outer longitudinal muscle
Which part of the muscle is contracting during swallowing and which is relaxaing?
1. Circular muscle contraction after the bolus
2. Circular muscle relaxation before the bolus
What are the two types of movement in the esophagus and describe them?
Dysphagia common etiologies
1. Originating in the lumen? 1
2. Originating in the wall? 3 main ones, 3 more rare
3. Originating outside the wall? 1 main, 3 more rare
4. Neuromuscular disorders? 1 main, 1 more rare
1. ^ In the lumen
2. ^ In the wall
-Tumor of the esophagus*
-Plummer Vinson syndrome- iron deficiency anemia
-Scleroderma- replaced with collagen tissue that has no contractibility
-Chagas’ disease- infectious.
3. ^ Outside the wall
-Pressure of enlarged lymph nodes*
-Thoracic aortic aneurysm
4. ^ Neuromuscular disorders
1. UES moves how?
2. LES moves how?
3. Longitudinal and circular muscle moves how?
1. UES….closes and relaxes
2. LES….base line tone. Mostly stays shut
3. Longitudinal and circular muscle…peristalsis
Normal phases of swallowing
1. The voluntary part of swallowing consists of what?
2. Involuntary swallowing consists of what? 3
1. Oropharyngeal phase – bolus is voluntarily moved into the pharynx
1. UES relaxation
2. peristalsis (aboral movement)
3. LES relaxation
1. UES prevents what? 2
2. LES prevents what? 1
-prevents air entering the esophagus during inspiration and
-prevents esophagopharyngeal reflux
2. gastroesophageal reflux
2. Anatomic & Structural
6. Miscellaneous (Perforation, Burns, Bleeding)
What kind of epithethium makes up the esophagus?
Oropharyngeal dysphagia (transfer dysphagia)
1. Patients complain of what?
2. What may cause symtpoms?
1. patients complain of difficulty swallowing
2. tracheal aspiration may cause symptoms
What are some pharyngoesophageal neuromusclar disorders?
5. multiple sclerosis
7. myasthenia gravis
8. dermatomyositis and polymyositis
Upper esophageal sphincter dysfunction/HTN aka?
What is a achalasia?
Incomplete relaxation of lower sphincter during swallowing leading to functional obstruction and proximal dilatation
(failure to relax)
1. PP: 3 contributing factors?
2. What structures are usually dimished or absent?
3. Histology findings?
4. Hypotheses for etiologies? 2
5. 5% develop what?
-increased resting tone
2. Ganglion cells of the myenteric plexus are diminished or absent
3. Histology: Inflammation in the area of M. plexus
4. Hypotheses: autoimmune, viral infections
5. 5% develop squamous cell carcinoma
Clincial picture of Achalasia:
1. Dysphagia (most common)
3. Chest pain
5. Weight loss
1. 25-50% report episodes of what?
2. 80-90% experience spontaneous what?
3. some patients may present with signs or symptoms of what?
1. retrosternal chest pain
Lab studies for Achalasia? 1
Imaging studies? 3 (and what will the findings be?)
The radiologic examination of choice in the diagnosis of achalasia is what?
1. Laboratory studies are noncontributory.
1. UGI: Bird’s Beak.
2. EGD: Normal or dilated esophagus.
Test of Choice: a barium swallow study performed under fluoroscopic guidance.
Normal esophageal mucosa appears what color?
white to tan
What is esophageal manometry used to assess? 2
Used to assess LES pressure & peristalsis
1. The goal of therapy for achalasia is to do what?
2. What are our two types of treatment?
1. relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing LES.
Diffuse Esophageal Spasm (DES) Characteristics
1. Chest pain
2. Intermittent dysphagia
3. Segmental non-peristaltic contractions
4. Corkscrew esophagus
5. Muscular hypertrophy
What is a nutcracker esophagus characterized by?
High pressure peristaltic contractions
(Nutcracker esophagus, or Hypertensive peristalsis, is a disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration.)
What is esophageal atresia?
congenital abnormality in which the mid-portion of the esophagus is absent
What is a TE fistula?
What are the etiologies depending on age? 2
A tracheoesophageal fistula is an abnormal connection (fistula) between the esophagus and the trachea.
TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as a laryngectomy.
What will show that the tube has not reached the abdomen suggesting either atresia or a fistula?
A plain radiograph will confirm the tube has not reached the stomach
Absence of gas in the abdomen suggests that the patient has either what or what?
1. atresia without a fistula or
2. atresia with a proximal fistula only
Gastroesophageal reflux (GERD) is defined as what?
Mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
PP of GERD?
-Primary barrier to gastroesophageal reflux is the lower esophageal sphincter
-LES normally works in conjunction with the diaphragm
-If barrier disrupted, acid goes from stomach to esophagus**
WHat are the four major physiological mechanisms that protect against esophageal acid injury?