Esophagus - Anatomy, Function, and Diseases

Synonyms

Throat, esophageal mouth

introduction

The average length of the esophagus (esophagus) in adults is 25-30 cm. It is a muscle tube that connects the oral cavity and the stomach and is mainly responsible for transporting food after ingestion.

Figure esophagus

1. esophagus
   (Neck section) -
   Esophagus, pars cervicalis
2. Nasal cavity - Cavitas nasi
3. Oral cavity - Cavitas oris
4. Trachea (approx. 20 cm) - Trachea
5. esophagus
   (Chest section) -
   Esophagus, pars thoracica
6. esophagus
   (Abdominal section) -
   Esophagus, pars abdominalis
7. Stomach entrance -
   Cardia
8. Stomach body -
   Corpus gastricum
9. Throat -
   Pharynx
10. Thyroid -
    Glandula thyroidea

You can find an overview of all Dr-Gumpert images at: medical illustrations

Illustration of the esophagus

from the larynx to the diaphragm / stomach

1. Cricoid cartilage
2. Aortic narrowing (end of the abdominal artery)
3. Zwerfellenge

1. thyroid
2. Carotid artery
3. Windpipe (trachea)
4. right main brochius (bronchi)
5. esophagus
6. Diaphragm

The esophagus (Esophagus) is an average of 25-30 cm long in adults. It is a muscle tube that connects the oral cavity and the stomach and is mainly responsible for transporting food after ingestion.

The esophagus can be divided into three parts:

1. Neck part: The esophagus begins behind the Larynx (Larynx). The part of the esophagus up to the point of entry into the chest is called the neck part.
2. Chest part: The chest section (in Rib cage) makes up the longest part of the total length of the esophagus at approx. 16 cm. Here the esophagus is in close proximity to the windpipe (Trachea), strictly speaking, it lies behind this and slightly to the left. As it continues, the esophagus lies behind the heart (Cor).
3. Belly part: It then reaches the esophagus through an opening in the diaphragm (Esophageal hiatus) the abdominal cavity (Abdomen). In the abdomen, it is only 1-4 cm long and then flows into the stomach. The opening in the diaphragm is formed by a loop of the diaphragm muscle that closes the entrance to the stomach when inhaled deeply. This mechanism can be disturbed and thus acquire disease value (Reflux esophagitis).

The esophagus is not equally strong in all sections. There are several natural bottlenecks in its course: These arise due to the relationship between the esophagus and other organs:

• The first narrow point is directly behind the larynx and forms the narrowest point with an average of only 13 mm; they are also called that Esophageal mouth.
• The second bottleneck is at the level of the reverse arch of the main artery (aorta) in the Rib cage (thorax).
• The last constriction is formed by the muscular tube of the diaphragm at the entrance to the abdominal cavity. This structure is also known as lower esophageal sphincter (esophageal sphincter).

These constrictions are particularly at risk for injuries to the esophagus from foreign bodies and chemical burns (alkalis, acids).

Several layers of tissue can be distinguished on the esophageal cross-section:

Layer structure of the esophagus from the inside out:

• Tunica mucosa: This innermost layer of the esophagus forms the lining of the esophagus. It consists of three sub-layers:
  • Because of the strong mechanical stress, the esophagus is multilayered Mucous membrane (uncorned Squamous epithelium) lined.
  • The lamina propria is loose connective tissue shifting layer
  • The lamina muskularis mucosae is one narrow muscle layer which adapts the surface of the food's mucous membrane.
    
• Tela submucosa: It is a loose layer of connective tissue. The main function is that of a shifting layer. The esophageal glands (glandulae esophageae) are also located here. The glandulae esophageae are glands that form an esophageal mucus that makes the mucous membrane slippery. In addition, a plexus of veins (vascular plexus) spreads in this esophageal layer, which is particularly pronounced in the lowest section of the esophagus.
  
• Tunica muscularis: The Tunica muscularis consists of a two-part muscle layer:
  • The Circular stratum is a ring-shaped and helical layer of muscle that contracts in a wave-like manner and is responsible for the forward transport of food (Peristalsis = wave movement).
  • The Stratum longitudinal is a layer of muscle that runs along the length of the esophagus. Through controlled muscle tension, it is able to (Contraction) to shorten the esophagus in sections and also ensure its longitudinal tension (= wave movement).
  • Tunica adventitia: This connective tissue cushion connects the esophagus with its neighboring structures, e.g. the windpipe (trachea). It is only a loose connection so that the mobility required for peristalsis is guaranteed.

Figure digestive tract

1. Throat / throat
2. Esophagus / esophagus
3. Stomach entrance at diaphragm level (Diaphragm)
4. Stomach (Guest)

function

The swallowing process

The main role of the esophagus is the to carry ingested food into the stomach. In the mouth, the person can still control the swallowing process at will, but from the throat the food is transported involuntarily (reflexively) via a complicated sequence from the center (the brain related) controlled muscle functions. The longitudinal muscle layer of the esophagus creates a Muscle wavethat propels the food towards the stomach. If the esophageal function is undisturbed, the muscles behind the chunks of food contract (contract) and push them in front of you. That kind of propulsive movement that peristalsis is called, encounters us throughout Gastrointestinal tract.

When swallowing it is very important that the respiratory tract reflexively closed so that no food components can be inhaled (aspirated).

Another very important task of the esophagus is to prevent acidic stomach contents from entering the esophagus (Reflux).

The last centimeters of the esophagus are always closed at rest. This fact is of particular importance, as this prevents the acidic stomach contents from flowing back into the esophagus and damaging the esophageal mucosa (Reflux esophagitis).

The following anatomical conditions play a role here:

1. The muscular loop of the Diaphragm compresses the esophagus from the outside (lower esophageal sphincter).
2. The esophagus is under continuous longitudinal muscular tension. Shortly before the stomach opening, the muscle layer is particularly twisted around the longitudinal axis, so that a kind of muscular twist lock is created.
3. The pressure ratios between Rib cage (Negative pressure) and abdominal cavity (positive pressure) differ, with the overpressure in the abdomen compressing the esophagus from the outside. This function is also known as "functional cardiac sphincter ".
4. A dense plexus of veins in the Tela submucosa (see above) forms a kind of cushion which narrows the passage, but at the same time remains soft so that the food can pass through.
5. Minimal, short lasting reflux is normal (physiological). In the healthy esophagus, rapid self-cleaning is ensured by the constant peristalsis that the Stomach acid immediately back to the stomach promoted so that it cannot cause any harm. It also causes swallowing saliva a Neutralization of the acid.

Cross section through the esophagus

(Fabric stained)

1. Tunica mucosa (mucous membrane)
2. Tela submucosa
3. Tunica muscularis

Pain in the esophagus

Various conditions affecting the esophagus can cause pain. Depending on the localization of the disease on the esophagus project the pain continues above or below in the area behind the sternum.

Often times, esophageal pain is caused by reflux esophagitis (heartburn) caused. Here it comes to one Escape (reflux) of stomach acid into the lower part of the esophaguswhere this irritates the mucous membrane. A burning sensation and acid belching are the result.
With the so-called Achalasia is the lower sphincter the esophagus ill and can no longer open properly. In addition, the Mobility of the esophagus severely restricted. Severe pain, especially while eating, is the result, making it frequent Weight loss comes.
Also so-called Esophageal diverticulum can cause pain in the esophagus, which is a abnormal bulging of the esophagus, mostly in the upper third. At first, the protrusions lead to a feeling of foreign body and difficulty swallowing, later to pain behind the breastbone. If food debris collects in the sac of the diverticulum, it can cause bad breath.
In rarer cases you can Tumors (benign or malignant changes in the lining of the esophagus) may be the cause of esophageal pain. For this reason, long-term pain in the esophagus should always be clarified by a doctor.

Esophagus is inflamed

A inflamed esophagus can have different causes. A typical cause is, for example, the frequent occurrence of Reflux (which is not necessarily perceived by the patient). The esophagus is of a special kind Mucous membrane lined, which are not for long-term contact with the acidic Gastric juice is created. If it does happen, one develops inflammation, partly also with visible ones Damage (Erosions).

Other causes of an inflamed esophagus can be Swallowing acids or foreign bodies be. Some too Medication, Irradiations as well as a Nasogastric tube can cause inflammation of the esophagus.

Also apply Alcohol abuse and Infections as a trigger of an inflamed esophagus. Possible pathogens are above all Mushrooms and Viruses, the emergence of such inflammation, mostly due to a weakness of the Immune system based. An ongoing one Inflammation of the esophagus can cause Ulcers,Cracks (rupture of the esophagus), Bleeding and even scar arise. These can narrow the esophagus and so the Passage of food to disturb.

Typical symptoms of esophagitis are difficulties swallowing and Pain, which are classically behind the Sternum ("Retrosternal") and lie in the upper abdomen. But also Vomit and diarrhea, Blood in your stool, or a tightness in your throat may indicate an inflamed esophagus. Especially when the Inflammation of the esophagus due to reflux disease is common heartburn laments.

If the symptoms point to an inflamed esophagus, a so-called Esophagoscopy (Reflection of the esophagus) carried out. The esophagus is examined with a small camera for changes in the mucous membrane and signs of inflammation. Also can Tissue samples be taken.

If the reflection confirms the suspicion of an inflamed esophagus, therapy is carried out depending on the respective cause. A Reflux disease for example becomes predominantly medicinal treated, means of first choice are here Proton pump inhibitorswhich control acid production in the stomach reduce. Are infectious agents like Viruses or Mushrooms the cause of the inflamed esophagus is treated with drugs that are especially effective against it. If it is already closed Constrictions If it has come down the esophagus, it may be necessary to do this again to widen ("Bougienage").

Burned esophagus

A burned esophagus is a rare clinical picture, as the shrinking from food that is too hot is a reflex that can already be found in children. As a result, a bite or liquid that is too hot is usually not put into the mouth in the first place.

However, if this is the case and the esophagus is burned, the person affected typically experiences a strong burning sensation in the chest cavity and difficulty swallowing. The burned areas can swell and cause shortness of breath. It can also lead to a fever.

The diagnosis is usually made on the basis of an examination with a lamp and mirror, but endoscopy and x-rays can also help. It is also important to rule out chemical burns.

A burned esophagus is treated by cleaning it. The throat and esophagus are rinsed through a tube. Antibiotics and steroids are also given as a precaution to prevent inflammation and swelling. Patients should have regular follow-up examinations after severe burns to the esophagus, as the tissue often scars and can lead to swallowing difficulties, shortness of breath, or esophageal cancer.

Burning esophagus from heartburn

If the Burns esophagus, one also speaks of heartburn. This describes the typical symptoms: a Burnwhich often from the stomach to the throat enough. Also acid regurgitation can occur.

Usually one prevents sphincter at the entrance of the stomach that the Stomach acid passes into the esophagus. This mechanism does not work properly for people with these complaints. The reasons for this are numerous, including, for example Obesity, constricting clothing, too lush or high fat meal, stress or a congenital disorder of the muscle. Since the mucous membrane that lines the esophagus should not have any contact with the stomach acid, it has no protective mechanism against this acid.

To prevent heartburn, should Obesity reduced as well coffee, alcohol, nicotine and hot spices avoided become. Above all in the evening, no lavish, high-fat meals should be consumed; it may also be useful to have them with head elevated to sleep.

You can find a lot more information under our topic: heartburn

Inflammation of the esophagus

A Inflammation of the esophagus describes in a narrower sense the inflammation of the mucous membrane that lines the esophagus. Most of the time that is included lower third affected. Typically, those affected complain heartburn and belching, sometimes over difficulties swallowing and Shortness of breath.

There are several causes of esophagitis, the most common being one Stomach acid leakage from the stomach. This is usually done by a sphincter prevents various factors (e.g. coffee, nicotine) can, however, impair its function.

By Obesity or pregnancy will the Increased pressure in the abdomenso it is common too Gastric acid reflux comes.
This causes the lining of the esophagus to come into contact with acid. Since this contact does not usually occur, the mucous membrane is unable to protect itself from the acid, which can lead to esophagitis.

You can also read about this: Heartburn during pregnancy

Even the accidental one Ingestion of corrosive substances or sharp objects can cause esophagitis. Besides that, you can infectious causes like above all Mushrooms and Viruses cause esophagitis. This is most common when the immune system, for example by AIDS or certain medications are weakened.

Diagnosed is caused by an esophagitis reflection, the therapy he follows depending on the cause.

Narrowed esophagus

A narrowing of the esophagus affects mostly the lower section of the esophagus and has the consequence that the food can no longer be transported sufficiently into the stomach. The patients complain about difficulties swallowing (Dysphagia) and Pain when swallowing (Odynophagia). Also a increased belching and bad breath odor can result. A narrowing of the esophagus is very common by a reflux disease (heartburn) caused. The backflow of acidic gastric juice into the esophagus irritates its mucous membrane and an inflammatory and remodeling reaction is triggered, in the course of which the lower section of the esophagus is thickened and narrowed.

Less often one can tumor the esophageal mucous membrane narrowing, so that malignancy can usually be ruled out in the event of such complaints. Certain anatomical relationships like a enlarged thyroid or scars from previous surgery can narrow the esophagus.
Very Rare it comes with children symptoms caused by congenital narrowing of the esophagus. A more common cause is the so-called Achalasiawhere the lower sphincter that separates the esophagus from the stomach is permanently tense. This makes it more difficult for the food to be transported into the stomach. The cause is the death of nerve cells that are responsible for the contraction of the muscles in the esophagus. In response to the lack of relaxation, there is one hypertrophy (Thickening of the muscles) of the section above the sphincter muscle.

Pain in the esophagus when eating

To be differentiated at Pain in the esophagusthat are triggered by eating is at what time the pain occurs. The pain throughout the esophagus can appear at any point between the upper neck and the lower sternum. Does it come to sharp pain during swallowing, is a Narrowness of the esophagus probably. The food pulp is held up in the place and leads to a sharp pain in the mucous membrane and esophagus.

If the pain doesn't appear until a few minutes after you eat, it is most likely one acid-induced pain. Burning behind the breastbone is typical. The best therapy for acid-induced burning of the esophagus is a change in diet and some lifestyle habits. Serious long-term complications can arise from ignoring the annoying burning sensation.

Pain in the esophagus after vomiting

Many people experience vomiting after vomiting Esophageal pain on. This is also due to the Stomach acidwhich attacks the cells of the lining of the esophagus. When vomiting, the entire stomach contents are expelled by a strong contraction of the stomach muscles. The stomach contents consist of the chyme that has mixed with stomach acid in the stomach. As a result of vomiting, the stomach acid is distributed over the entire mucous membrane of the esophagus and can lead to the burning pain to lead similar to heartburn.

A single vomiting does not pose any long-term risks and usually does not damage the esophagus. However, caution is advised with frequent vomiting, for example in the context of bulimia or alcohol abuse. Even vomiting regularly once every two weeks can be harmful. In contrast to heartburn, significantly larger amounts of gastric acid are transported out of the stomach. The mucous membrane cells of the esophagus are unable to fight off stomach acid and it comes to Inflammation of the mucous membrane and long term to Transformation of cells. This is already irreversible damage. Immediately after vomiting, teas or light foods can help relieve the pain and remove the hydrochloric acid from the esophagus.