The esophagus (

American English American English, sometimes called United States English or U.S. English, is the set of variety (linguistics), varieties of the English language native to the United States. English is the Languages of the United States, most widely spoken lan ...

) or oesophagus (

British English British English (BrE, en-GB, or BE) is, according to Lexico, Oxford Dictionaries, "English language, English as used in Great Britain, as distinct from that used elsewhere". More narrowly, it can refer specifically to the English language in ...

; both ), non-technically known also as the food pipe or gullet, is an

organ Organ may refer to: Biology * Organ (biology), a part of an organism Musical instruments * Organ (music), a family of keyboard musical instruments characterized by sustained tone ** Electronic organ, an electronic keyboard instrument ** Hammond ...

vertebrate Vertebrates () comprise all animal taxa within the subphylum Vertebrata () ( chordates with backbones), including all mammals, birds, reptiles, amphibians, and fish. Vertebrates represent the overwhelming majority of the phylum Chordata, ...

s through which

food Food is any substance consumed by an organism for nutritional support. Food is usually of plant, animal, or fungal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals. The substance is inge ...

passes, aided by peristaltic contractions, from the

pharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struc ...

to the

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

. The esophagus is a fibromuscular tube, about long in adults, that travels behind the

trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...

and

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...

, passes through the

diaphragm Diaphragm may refer to: Anatomy * Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen * Pelvic diaphragm or pelvic floor, a pelvic structure * Urogenital diaphragm or triangular ligament, a pelvic structure Other * Diap ...

, and empties into the uppermost region of the

. During swallowing, the

epiglottis The epiglottis is a leaf-shaped flap in the throat that prevents food and water from entering the trachea and the lungs. It stays open during breathing, allowing air into the larynx. During swallowing, it closes to prevent aspiration of food int ...

tilts backwards to prevent food from going down the

larynx The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...

and lungs. The word ''oesophagus'' is from Ancient Greek οἰσοφάγος (oisophágos), from οἴσω (oísō), future form of φέρω (phérō, “I carry”) + ἔφαγον (éphagon, “I ate”). The wall of the esophagus from the lumen outwards consists of

mucosa A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...

submucosa The submucosa (or tela submucosa) is a thin layer of tissue (biology), tissue in various organ (anatomy), organs of the gastrointestinal tract, gastrointestinal, respiratory tract, respiratory, and genitourinary system, genitourinary tracts. It i ...

(connective tissue), layers of muscle fibers between layers of

fibrous tissue Fiber or fibre (from la, fibra, links=no) is a natural or artificial substance that is significantly longer than it is wide. Fibers are often used in the manufacture of other materials. The strongest engineering materials often incorporate ...

, and an outer layer of connective tissue. The mucosa is a

stratified squamous epithelium A stratified squamous epithelium consists of squamous (flattened) epithelial cells arranged in layers upon a basal membrane. Only one layer is in contact with the basement membrane; the other layers adhere to one another to maintain structural i ...

of around three layers of squamous cells, which contrasts to the single layer of columnar cells of the stomach. The transition between these two types of epithelium is visible as a zig-zag line. Most of the muscle is

smooth muscle Smooth muscle is an involuntary non-striated muscle, so-called because it has no sarcomeres and therefore no striations (''bands'' or ''stripes''). It is divided into two subgroups, single-unit and multiunit smooth muscle. Within single-unit mus ...

although

striated muscle Striations means a series of ridges, furrows or linear marks, and is used in several ways: * Glacial striation * Striation (fatigue), in material * Striation (geology), a ''striation'' as a result of a geological fault * Striation Valley, in Ant ...

predominates in its upper third. It has two muscular rings or

sphincter A sphincter is a circular muscle that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning. Sphincters are found in many animals. There are over 60 types in the hum ...

s in its wall, one at the top and one at the bottom. The lower sphincter helps to prevent reflux of acidic stomach content. The esophagus has a rich blood supply and venous drainage. Its smooth muscle is innervated by involuntary nerves (

sympathetic nerve The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of the ...

s via the

sympathetic trunk The sympathetic trunks (sympathetic chain, gangliated cord) are a paired bundle of nerve fibers that run from the base of the skull to the coccyx. They are a major component of the sympathetic nervous system. Structure The sympathetic trunk lies j ...

and

parasympathetic nerve The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of t ...

s via the

vagus nerve The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and right ...

) and in addition voluntary nerves (

lower motor neurons Lower motor neurons (LMNs) are motor neurons located in either the anterior grey column, anterior nerve roots (spinal lower motor neurons) or the cranial nerve nuclei of the brainstem and cranial nerves with motor function (cranial nerve lower mo ...

) which are carried in the vagus nerve to innervate its striated muscle. The esophagus passes through the thoracic cavity into the

into the stomach. The esophagus may be affected by

gastric reflux Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

, prominent dilated blood vessels called

varices A varix (pl. varices) is an abnormally dilated vessel with a tortuous course. Varices usually occur in the venous system, but may also occur in arterial or lymphatic vessels. Examples of varices include: * Varicose veins, large tortuous veins usua ...

that can bleed heavily,

tears Tears are a clear liquid secreted by the lacrimal glands (tear gland) found in the eyes of all land mammals. Tears are made up of water, electrolytes, proteins, lipids, and mucins that form layers on the surface of eyes. The different types of ...

, constrictions, and disorders of motility. Diseases may cause difficulty swallowing (

dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a disease#Terminology, condition in its own right. It may be a sensation that suggests difficulty in the passag ...

), painful swallowing (

odynophagia Odynophagia is pain when swallowing. The pain may be felt in the mouth or throat and can occur with or without difficulty swallowing. The pain may be described as an ache, burning sensation, or occasionally a stabbing pain that radiates to the b ...

chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...

, or cause no symptoms at all. Clinical investigations include

X-rays An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 Picometre, picometers to 10 Nanometre, nanometers, corresponding to frequency, ...

when swallowing

barium sulfate Barium sulfate (or sulphate) is the inorganic compound with the chemical formula Ba SO4. It is a white crystalline solid that is odorless and insoluble in water. It occurs as the mineral barite, which is the main commercial source of barium an ...

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

, and

CT scan A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...

s. Surgically, the esophagus is difficult to access in part due to its position between critical organs and directly between the sternum and spinal column.

Structure

The esophagus is one of the upper parts of the

digestive system The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion (the tongue, salivary glands, pancreas, liver, and gallbladder). Digestion involves the breakdown of food into smaller and smaller compone ...

. There are

taste bud Taste buds contain the taste receptor cells, which are also known as gustatory cells. The taste receptors are located around the small structures known as lingual papillae, papillae found on the upper surface of the tongue, soft palate, upper e ...

s on its upper part. It begins at the back of the mouth, passing downward through the rear part of the

mediastinum The mediastinum (from ) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagu ...

, through the

, and into the stomach. In humans, the esophagus generally starts around the level of the sixth

cervical vertebra In tetrapods, cervical vertebrae (singular: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In sau ...

behind the

cricoid cartilage The cricoid cartilage , or simply cricoid (from the Greek ''krikoeides'' meaning "ring-shaped") or cricoid ring, is the only complete ring of cartilage around the trachea. It forms the back part of the voice box and functions as an attachment si ...

of the

, enters the diaphragm at about the level of the

tenth thoracic vertebra In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebrae and they are intermediate in size between the cervical ...

, and ends at the

cardia The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach is ...

of the stomach, at the level of the

eleventh thoracic vertebra In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebrae and they are intermediate in size between the cervical ...

. The esophagus is usually about 25 cm (10 in) in length. Many

blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...

s serve the esophagus, with blood supply varying along its course. The upper parts of the esophagus and the upper esophageal sphincter receive blood from the

inferior thyroid artery The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle. It then turns medially behind the carotid sheath and its contents, and als ...

, the parts of the esophagus in the thorax from the

bronchial arteries In human anatomy, the bronchial arteries supply the lungs with nutrition and oxygenated blood. Although there is much variation, there are usually two bronchial arteries that run to the left lung, and one to the right lung and are a vital part of ...

and branches directly from the

thoracic aorta The descending thoracic aorta is a part of the aorta located in the thorax. It is a continuation of the aortic arch. It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity. The descending thoracic ...

, and the lower parts of the esophagus and the lower esophageal sphincter receive blood from the

left gastric artery In human anatomy, the left gastric artery arises from the celiac artery and runs along the superior portion of the lesser curvature of the stomach. Branches also supply the lower esophagus. The left gastric artery anastomoses with the right gas ...

and the left

inferior phrenic artery The inferior phrenic arteries are two small vessels which supply the diaphragm. They present much variety in their origin. Structure Origin The inferior phrenic arteries usually arise between T12 and L2 vertebrae. They may arise separately ...

. The venous drainage also differs along the course of the esophagus. The upper and middle parts of the esophagus drain into the azygos and

hemiazygos vein The hemiazygos vein (vena azygos minor inferior) is a vein running superiorly in the lower thoracic region, just to the left side of the vertebral column. Structure The hemiazygos vein and the accessory hemiazygos vein, when taken together, essen ...

s, and blood from the lower part drains into the

left gastric vein The left gastric vein (or coronary vein) is a vein that derives from tributaries draining the lesser curvature of the stomach. Structure The left gastric vein runs from right to left along the lesser curvature of the stomach. It passes to the ...

. All these veins drain into the

superior vena cava The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein th ...

, with the exception of the left gastric vein, which is a branch of the

portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...

. Lymphatically, the upper third of the esophagus drains into the

deep cervical lymph node The deep cervical lymph nodes are a group of cervical lymph nodes found near the internal jugular vein in the neck. Structure The deep cervical lymph nodes can be divided into upper and lower groups, or superior and inferior groups. Alternati ...

s, the middle into the superior and posterior mediastinal lymph nodes, and the lower esophagus into the

gastric The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

and

celiac lymph nodes The celiac lymph nodes are associated with the branches of the celiac artery. Other lymph nodes in the abdomen are associated with the superior mesenteric artery, superior and inferior mesenteric artery, inferior mesenteric arteries. The celiac ly ...

. This is similar to the lymphatic drainage of the abdominal structures that arise from the

foregut The foregut is the anterior part of the alimentary canal, from the mouth to the duodenum at the entrance of the bile duct. Beyond the stomach, the foregut is attached to the abdominal walls by mesentery. The foregut arises from the endoderm, deve ...

, which all drain into the celiac nodes. ;Position The upper esophagus lies at the back of the mediastinum behind the

, adjoining along the

tracheoesophageal stripe The tracheoesophageal stripe is formed by the posterior wall of the trachea and the anterior wall of the esophagus The esophagus ( American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet ...

, and in front of the

erector spinae muscle The erector spinae ( ) or spinal erectors is a set of muscles that straighten and rotate the back. The spinal erectors work together with the glutes (gluteus maximus, gluteus medius and gluteus minimus) to maintain stable posture standing or s ...

s and the

vertebral column The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordata, ...

. The lower esophagus lies behind the

and curves in front of the

. From the

bifurcation of the trachea In anatomy, the carina or tracheal bifurcation is a ridge of cartilage in the trachea that occurs between the division of the two main bronchi. Structure The carina occurs at the lower end of the trachea (usually at the level of the 4th to 5th ...

downwards, the esophagus passes behind the right

pulmonary artery A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the ''main pulmonary artery'' or ''pulmonary trunk'' from the heart, and t ...

left main bronchus A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi pronounced (BRAN-KAI) to branch from the trachea at the carina are the right main bronchus and the left main bronchus. ...

, and

left atrium The atrium ( la, ātrium, , entry hall) is one of two upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the heart ventricles through the atrioventricular valves. There are two atr ...

. At this point, it passes through the diaphragm. The

thoracic duct In human anatomy, the thoracic duct is the larger of the two lymph ducts of the lymphatic system. It is also known as the ''left lymphatic duct'', ''alimentary duct'', ''chyliferous duct'', and ''Van Hoorne's canal''. The other duct is the right ...

, which drains the majority of the body's

lymph Lymph (from Latin, , meaning "water") is the fluid that flows through the lymphatic system, a system composed of lymph vessels (channels) and intervening lymph nodes whose function, like the venous system, is to return fluid from the tissues to ...

, passes behind the esophagus, curving from lying behind the esophagus on the right in the lower part of the esophagus, to lying behind the esophagus on the left in the upper esophagus. The esophagus also lies in front of parts of the

s and the

intercostal vein The intercostal veins are a group of veins which drain the area between the ribs ("costae"), called the intercostal space. They can be divided as follows: * Anterior intercostal veins * Posterior intercostal veins ** Posterior intercost vein tha ...

s on the right side. The

divides and covers the esophagus in a

plexus In neuroanatomy, a plexus (from the Latin term for "braid") is a branching network of vessels or nerves. The vessels may be blood vessels (veins, capillaries) or lymphatic vessels. The nerves are typically axons outside the central nervous syste ...

. ;Constrictions Illu esophagus

The esophagus has four points of constriction. When a corrosive substance, or a solid object is swallowed, it is most likely to lodge and damage one of these four points. These constrictions arise from particular structures that compress the esophagus. These constrictions are: * At the start of the esophagus, where the

laryngopharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struc ...

joins the esophagus, behind the

* Where it is crossed on the front by the

aortic arch The aortic arch, arch of the aorta, or transverse aortic arch () is the part of the aorta between the ascending and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea. Structure The aorta begins a ...

in the superior

* Where the esophagus is compressed by the left main

bronchus A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi pronounced (BRAN-KAI) to branch from the trachea at the carina are the right main bronchus and the left main bronchus. ...

in the posterior mediastinum * The

esophageal hiatus In human anatomy, the esophageal hiatus is an opening in the diaphragm through which the esophagus and the vagus nerve pass. Structure It is located in the right crus, one of the two tendinous structures that connect the diaphragm to the s ...

, where it passes through the

in the posterior mediastinum

Sphincters

The esophagus is surrounded at the top and bottom by two muscular rings, known respectively as the upper esophageal sphincter and the lower esophageal sphincter. These

s act to close the esophagus when food is not being swallowed. The upper esophageal sphincter is an anatomical sphincter, which is formed by the lower portion of the inferior pharyngeal constrictor, also known as the cricopharyngeal sphincter due to its relation with

of the

anteriorly. However, the lower esophageal sphincter is not an anatomical but rather a functional sphincter, meaning that it acts as a sphincter but does not have a distinct thickening like other sphincters. The upper esophageal sphincter surrounds the upper part of the esophagus. It consists of

skeletal muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

but is not under voluntary control. Opening of the upper esophageal sphincter is triggered by the swallowing reflex. The primary muscle of the upper esophageal sphincter is the cricopharyngeal part of the

inferior pharyngeal constrictor The inferior pharyngeal constrictor muscle is a skeletal muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of ...

. The lower esophageal sphincter, or gastroesophageal sphincter, surrounds the lower part of the esophagus at the junction between the esophagus and the stomach. It is also called the cardiac sphincter or cardioesophageal sphincter, named from the adjacent part of the stomach, the ''

''. Dysfunction of the gastroesophageal sphincter causes gastroesophageal

reflux Reflux is a technique involving the condensation of vapors and the return of this condensate to the system from which it originated. It is used in industrial and laboratory distillations. It is also used in chemistry to supply energy to reactions ...

, which causes

heartburn Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid (gastric reflux) into the esophagus. It is the ma ...

, and, if it happens often enough, can lead to

gastroesophageal reflux disease Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...

, with damage of the esophageal mucosa.

Nerve supply

The esophagus is innervated by the vagus nerve and the cervical and thoracic

. The vagus nerve has a

parasympathetic The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of t ...

function, supplying the muscles of the esophagus and stimulating glandular contraction. Two sets of nerve fibers travel in the vagus nerve to supply the muscles. The upper striated muscle, and upper esophageal sphincter, are supplied by neurons with bodies in the

nucleus ambiguus The nucleus ambiguus ("ambiguous nucleus" in English) is a group of large motor neurons, situated deep in the medullary reticular formation named by Jacob Clarke. The nucleus ambiguus contains the cell bodies of neurons that innervate the muscles ...

, whereas fibers that supply the smooth muscle and lower esophageal sphincter have bodies situated in the

dorsal motor nucleus The dorsal nucleus of vagus nerve (or posterior nucleus of vagus nerve or dorsal vagal nucleus or nucleus dorsalis nervi vagi or nucleus posterior nervi vagi) is a cranial nerve nucleus for the vagus nerve in the medulla that lies ventral to the fl ...

. The vagus nerve plays the primary role in initiating

peristalsis Peristalsis ( , ) is a radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an anterograde direction. Peristalsis is progression of coordinated contraction of involuntary circular muscles, which ...

. The sympathetic trunk has a sympathetic function. It may enhance the function of the vagus nerve, increasing peristalsis and glandular activity, and causing sphincter contraction. In addition, sympathetic activation may relax the muscle wall and cause blood vessel constriction. Sensation along the esophagus is supplied by both nerves, with gross sensation being passed in the vagus nerve and pain passed up the sympathetic trunk.

Gastro-esophageal junction

The gastro-esophageal junction (also known as the esophagogastric junction) is the junction between the esophagus and the stomach, at the lower end of the esophagus. The pink color of the esophageal mucosa contrasts to the deeper red of the gastric mucosa, and the mucosal transition can be seen as an irregular zig-zag line, which is often called the z-line. Histological examination reveals abrupt transition between the

of the esophagus and the

simple columnar epithelium Simple columnar epithelium is a single layer of columnar epithelial cells which are tall and slender with oval-shaped nuclei located in the basal region, attached to the basement membrane. In humans, simple columnar epithelium lines most organ ...

of the

. Normally, the

of the stomach is immediately distal to the z-line and the z-line coincides with the upper limit of the gastric folds of the cardia; however, when the anatomy of the mucosa is distorted in

Barrett's esophagus Barrett's esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells ...

the true gastro-eshophageal junction can be identified by the upper limit of the gastric folds rather than the mucosal transition. The functional location of the lower oesophageal sphincter is generally situated about below the z-line.

Microanatomy

The human esophagus has a

mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...

consisting of a tough

without

keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. Alpha-keratin (α-keratin) is a type of keratin found in vertebrates. It is the key structural material making up scales, hair, nails, feathers, ho ...

, a smooth

lamina propria The lamina propria is a thin layer of connective tissue that forms part of the moist linings known as mucous membranes or mucosae, which line various tubes in the body, such as the respiratory tract, the gastrointestinal tract, and the urogenita ...

, and a

muscularis mucosae The lamina muscularis mucosae (or muscularis mucosae) is a thin layer (lamina) of muscle of the gastrointestinal tract, located outside the lamina propria, and separating it from the submucosa. It is present in a continuous fashion from the esopha ...

. The epithelium of the esophagus has a relatively rapid turnover and serves a protective function against the abrasive effects of food. In many animals, the epithelium contains a layer of keratin, representing a coarser diet. There are two types of glands, with mucus-secreting

esophageal gland The esophageal glands are glands that are part of the digestive system of various animals, including humans. In humans Esophageal glands in humans are a part of a human digestive system. They are a small compound racemose exocrine glands of the mu ...

s being found in the

and esophageal cardiac glands, similar to

cardiac glands The gastric glands are glands in the gastric mucosa, lining of the stomach that play an essential role in the digestion, process of digestion. All of the glands have mucus-secreting foveolar cells. Mucus lines the entire stomach, and protects the ...

of the stomach, located in the lamina propria and most frequent in the terminal part of the organ. The

mucus Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is ...

from the glands gives a good protection to the lining. The submucosa also contains the

submucosal plexus The submucosal plexus (Meissner's plexus, plexus of the submucosa, plexus submucosus) lies in the submucosa of the intestinal wall. The nerves of this plexus are derived from the myenteric plexus which itself is derived from the plexuses of paras ...

, a network of

nerve cells A neuron, neurone, or nerve cell is an electrically excitable cell that communicates with other cells via specialized connections called synapses. The neuron is the main component of nervous tissue in all animals except sponges and placozoa. No ...

that is part of the

enteric nervous system The enteric nervous system (ENS) or intrinsic nervous system is one of the main divisions of the autonomic nervous system (ANS) and consists of a mesh-like system of neurons that governs the function of the gastrointestinal tract. It is capable of ...

. The

muscular layer The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...

of the esophagus has two types of muscle. The upper third of the esophagus contains

, the lower third contains

, and the middle third contains a mixture of both. Muscle is arranged in two layers: one in which the muscle fibers run longitudinal to the esophagus, and the other in which the fibers encircle the esophagus. These are separated by the

myenteric plexus The myenteric plexus (or Auerbach's plexus) provides motor innervation to both layers of the muscular layer of the gut, having both parasympathetic and sympathetic input (although present ganglion cell bodies belong to parasympathetic innervation ...

, a tangled network of nerve fibers involved in the secretion of mucus and in peristalsis of the smooth muscle of the esophagus. The outermost layer of the esophagus is the

adventitia The adventitia () is the outer layer of fibrous connective tissue surrounding an organ. The outer layer of connective tissue that surrounds an artery, or vein – the tunica externa, is also called the ''tunica adventitia''. To some degree, its ...

in most of its length, with the abdominal part being covered in

serosa The serous membrane (or serosa) is a smooth tissue membrane of mesothelium lining the contents and inner walls of body cavities, which secrete serous fluid to allow lubricated sliding movements between opposing surfaces. The serous membrane ...

. This makes it distinct from many other structures in the gastrointestinal tract that only have a serosa.

Development

In early

embryogenesis An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male sperm ...

, the esophagus develops from the

endoderm Endoderm is the innermost of the three primary germ layers in the very early embryo. The other two layers are the ectoderm (outside layer) and mesoderm (middle layer). Cells migrating inward along the archenteron form the inner layer of the gast ...

primitive gut tube Primitive may refer to: Mathematics * Primitive element (field theory) * Primitive element (finite field) * Primitive cell (crystallography) * Primitive notion, axiomatic systems * Primitive polynomial (disambiguation), one of two concepts * Prim ...

. The ventral part of the embryo abuts the

yolk sac The yolk sac is a membranous sac attached to an embryo, formed by cells of the hypoblast layer of the bilaminar embryonic disc. This is alternatively called the umbilical vesicle by the Terminologia Embryologica (TE), though ''yolk sac'' is far ...

. During the second week of embryological development, as the embryo grows, it begins to surround parts of the sac. The enveloped portions form the basis for the adult gastrointestinal tract. The sac is surrounded by a network of

vitelline arteries The vitelline arteries are the arterial counterpart to the vitelline veins. Like the veins, they play an important role in the vitelline circulation of blood to and from the yolk sac of a fetus. They are a branch of the dorsal aorta. They give ri ...

. Over time, these arteries consolidate into the three main arteries that supply the developing gastrointestinal tract: the

celiac artery The celiac () artery (also spelled ''coeliac''), also known as the celiac trunk or truncus coeliacus, is the first major branch of the abdominal aorta. It is about 1.25 cm in length. Branching from the aorta at thoracic vertebra 12 (T12) in ...

superior mesenteric artery In human anatomy, the superior mesenteric artery (SMA) is an artery which arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies blood to the intestine from the lower part of the ...

, and

inferior mesenteric artery In human anatomy, the inferior mesenteric artery, often abbreviated as IMA, is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the distal transverse colon to the upper part of the ana ...

. The areas supplied by these arteries are used to define the

midgut The midgut is the portion of the embryo from which most of the intestines develop. After it bends around the superior mesenteric artery, it is called the "midgut loop". It comprises the portion of the alimentary canal from the end of the foregut ...

hindgut The hindgut (or epigaster) is the posterior ( caudal) part of the alimentary canal. In mammals, it includes the distal one third of the transverse colon and the splenic flexure, the descending colon, sigmoid colon and up to the ano-rectal juncti ...

and

. The surrounded sac becomes the primitive gut. Sections of this gut begin to differentiate into the organs of the gastrointestinal tract, such as the esophagus,

, and

intestine The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans ...

s. The esophagus develops as part of the foregut tube. The innervation of the esophagus develops from the

pharyngeal arch The pharyngeal arches, also known as visceral arches'','' are structures seen in the embryonic development of vertebrates that are recognisable precursors for many structures. In fish, the arches are known as the branchial arches, or gill arch ...

es.

Function

Swallowing

Food is

ingested Ingestion is the consumption of a substance by an organism. In animals, it normally is accomplished by taking in a substance through the mouth into the gastrointestinal tract, such as through eating or drinking. In single-celled organisms inges ...

through the

mouth In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...

and when

swallowed Swallowing, sometimes called deglutition in scientific contexts, is the process in the human or animal body that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing i ...

passes first into the

and then into the esophagus. The esophagus is thus one of the first components of the

and the

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organ (biology), organs of the digestive syste ...

. After food passes through the esophagus, it enters the stomach. When food is being swallowed, the

moves backward to cover the

, preventing food from entering the

. At the same time, the upper esophageal sphincter relaxes, allowing a

bolus Bolus may refer to: Geography * Bolus, Iran, a village in Ardabil Province, Iran * Bolus, or Baulus, an Anatolian village on the site of ancient Berissa Medicine * Bolus (digestion), a ball-shaped mass moving through the digestive tract * Bolus ...

to enter.

Peristaltic Peristalsis ( , ) is a radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an anterograde direction. Peristalsis is progression of coordinated contraction of involuntary circular muscles, which ...

contractions of the esophageal muscle push the food down the esophagus. These rhythmic contractions occur both as a reflex response to food that is in the mouth, and also as a response to the sensation of food within the esophagus itself. Along with peristalsis, the lower esophageal sphincter relaxes.

Reducing gastric reflux

The stomach produces

gastric acid Gastric acid, gastric juice, or stomach acid is a digestive fluid formed within the stomach lining. With a pH between 1 and 3, gastric acid plays a key role in digestion of proteins by activating digestive enzymes, which together break down the ...

, a strongly

acid In computer science, ACID ( atomicity, consistency, isolation, durability) is a set of properties of database transactions intended to guarantee data validity despite errors, power failures, and other mishaps. In the context of databases, a sequ ...

ic mixture consisting of

hydrochloric acid Hydrochloric acid, also known as muriatic acid, is an aqueous solution of hydrogen chloride. It is a colorless solution with a distinctive pungent smell. It is classified as a strong acid Acid strength is the tendency of an acid, symbol ...

(HCl) and

potassium Potassium is the chemical element with the symbol K (from Neo-Latin ''kalium'') and atomic number19. Potassium is a silvery-white metal that is soft enough to be cut with a knife with little force. Potassium metal reacts rapidly with atmosphe ...

and

sodium Sodium is a chemical element with the symbol Na (from Latin ''natrium'') and atomic number 11. It is a soft, silvery-white, highly reactive metal. Sodium is an alkali metal, being in group 1 of the periodic table. Its only stable iso ...

salts to enable food

digestion Digestion is the breakdown of large insoluble food molecules into small water-soluble food molecules so that they can be absorbed into the watery blood plasma. In certain organisms, these smaller substances are absorbed through the small intest ...

. Constriction of the upper and lower esophageal sphincters helps to prevent reflux (backflow) of gastric contents and acid into the esophagus, protecting the esophageal mucosa. The acute

angle of His The angle of His, also known as the esophagogastric angle, is the acute angle created between the cardia at the entrance to the stomach, and the esophagus. It helps to prevent acid reflux of stomach acid into the esophagus. It is commonly undevel ...

and the lower

crura of the diaphragm The crus of diaphragm (pl. crura), refers to one of two tendon, tendinous structures that extends below the thoracic diaphragm, diaphragm to the vertebral column. There is a right crus and a left crus, which together form a tether for muscular cont ...

also help this sphincteric action.

Gene and protein expression

About 20,000 protein-coding genes are expressed in human cells and nearly 70% of these genes are expressed in the normal esophagus. Some 250 of these genes are more specifically expressed in the esophagus with less than 50 genes being highly specific. The corresponding esophagus-specific proteins are mainly involved in squamous differentiation such as

s KRT13, KRT4 and

KRT6C Keratin 6C (protein name K6C; gene name ''KRT6C''), is a type II cytokeratin, one of a number of isoforms of keratin 6 encoded by separate genes located within the type II keratin gene cluster on human chromosome 12q. This gene was uncovered recent ...

. Other specific proteins that help lubricate the inner surface of esophagus are

mucin Mucins () are a family of high molecular weight, heavily glycosylated proteins (glycoconjugates) produced by epithelial tissues in most animals. Mucins' key characteristic is their ability to form gels; therefore they are a key component in most ...

s such as

MUC21 Mucin 21, cell surface associated is a protein that in humans is encoded by the MUC21 gene In biology, the word gene (from , ; "... Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation ...

and MUC22. Many genes with elevated expression are also shared with skin and other organs that are composed of

squamous epithelia Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellu ...

Clinical significance

The main conditions affecting the esophagus are described here. For a more complete list, see

esophageal disease Esophageal can refer to: * The esophagus * Esophageal arteries * Esophageal glands The esophageal glands are glands that are part of the digestive system of various animals, including humans. In humans Esophageal glands in humans are a part of a ...

Inflammation

Inflammation of the esophagus is known as

esophagitis Esophagitis, also spelled oesophagitis, is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; s ...

Reflux Reflux is a technique involving the condensation of vapors and the return of this condensate to the system from which it originated. It is used in industrial and laboratory distillations. It is also used in chemistry to supply energy to reactions ...

s from the stomach, infection, substances ingested (for example, corrosives), some

medications A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...

(such as

bisphosphonate Bisphosphonates are a class of drugs that prevent the loss of bone density, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis. They are called bisphosphonates because they ...

s), and

food allergies A food allergy is an abnormal immune response to food. The symptoms of the allergic reaction may range from mild to severe. They may include itchiness, swelling of the tongue, vomiting, diarrhea, hives, trouble breathing, or low blood pressure ...

can all lead to esophagitis.

Esophageal candidiasis Esophageal candidiasis is an opportunistic infection of the esophagus by ''Candida albicans''. The disease usually occurs in patients in immunocompromised states, including post-chemotherapy and in AIDS. However, it can also occur in patients wi ...

is an infection of the yeast ''

Candida albicans ''Candida albicans'' is an opportunistic pathogenic yeast that is a common member of the human gut flora. It can also survive outside the human body. It is detected in the gastrointestinal tract and mouth in 40–60% of healthy adults. It is us ...

'' that may occur when a person is

immunocompromised Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...

. the causes of some forms of esophagitis, such as

eosinophilic esophagitis Eosinophilic esophagitis (EoE) is an allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cell. In healthy individuals, the esophagus is typically devoid of eosinophils. In EoE, eosinophils migrate t ...

, are not well-characterized, but may include

Th2 The T helper cells (Th cells), also known as CD4+ cells or CD4-positive cells, are a type of T cell that play an important role in the adaptive immune system. They aid the activity of other immune cells by releasing cytokines. They are considere ...

-mediated atopies or genetic factors. There appear to be correlations between eosinophilic esophagitis,

asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...

(itself with an

eosinophilic Eosinophilic (Greek suffix -phil-, meaning ''loves eosin'') is the staining of tissues, cells, or organelles after they have been washed with eosin, a dye. Eosin is an acidic dye for staining cell cytoplasm, collagen, and muscle fibers. ''Eosi ...

component),

eczema Dermatitis is inflammation of the Human skin, skin, typically characterized by itchiness, erythema, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become lichenification, thick ...

, and

allergic rhinitis Allergic rhinitis, of which the seasonal type is called hay fever, is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. Signs and symptoms include a runny or stuffy nose, sneezing, red, i ...

, though it is not clear whether these conditions contribute to eosinophilic esophagitis or vice versa, or if they are symptoms of mutual underlying factors. Esophagitis can cause painful swallowing and is usually treated by managing the cause of the esophagitis - such as managing reflux or treating infection.

Barrett's esophagus

Prolonged esophagitis, particularly from gastric reflux, is one factor thought to play a role in the development of

. In this condition, there is

metaplasia Metaplasia ( gr, "change in form") is the transformation of one differentiated cell type to another differentiated cell type. The change from one type of cell to another may be part of a normal maturation process, or caused by some sort of abno ...

of the lining of the lower esophagus, which changes from stratified squamous epithelia to

simple columnar epithelia Simple columnar epithelium is a single layer of columnar epithelial cells which are tall and slender with oval-shaped nuclei located in the basal region, attached to the basement membrane. In humans, simple columnar epithelium lines most organs ...

. Barrett's esophagus is thought to be one of the main contributors to the development of

esophageal cancer Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voice ...

Cancer

There are two main types of

cancer of the esophagus Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voice ...

Squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

is a

carcinoma Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal ...

that can occur in the squamous cells lining the esophagus. This type is much more common in

China China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...

and

Iran Iran, officially the Islamic Republic of Iran, and also called Persia, is a country located in Western Asia. It is bordered by Iraq and Turkey to the west, by Azerbaijan and Armenia to the northwest, by the Caspian Sea and Turkmeni ...

. The other main type is an

adenocarcinoma Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or ...

that occurs in the glands or columnar tissue of the esophagus. This is most common in

developed countries A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...

in those with Barrett's esophagus, and occurs in the cuboidal cells. In its early stages, esophageal cancer may not have any symptoms at all. When severe, esophageal cancer may eventually cause obstruction of the esophagus, making swallowing of any solid foods very difficult and causing weight loss. The progress of the cancer is staged using a system that measures how far into the esophageal wall the cancer has invaded, how many

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

s are affected, and whether there are any

metastases Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then, ...

in different parts of the body. Esophageal cancer is often managed with radiotherapy, chemotherapy, and may also be managed by partial surgical removal of the esophagus. Inserting a

stent In medicine, a stent is a metal or plastic tube inserted into the lumen of an anatomic vessel or duct to keep the passageway open, and stenting is the placement of a stent. A wide variety of stents are used for different purposes, from expandab ...

into the esophagus, or inserting a

nasogastric tube Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube or NG tube) through the nose, down the oesophagus, and down into the stomach. Orogastric intubation is a similar process involving the inserti ...

, may also be used to ensure that a person is able to digest enough food and water. , the prognosis for esophageal cancer is still poor, so

palliative therapy Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often Terminal illness, termi ...

may also be a focus of treatment.

Varices

Esophageal varices Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendency to develop ...

are swollen twisted branches of the

azygous vein The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood ...

in the lower third of the esophagus. These blood vessels

anastomose An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal ...

(join up) with those of the

when

portal hypertension Portal hypertension is abnormally increased portal venous pressure – blood pressure in the portal vein and its branches, that drain from most of the intestine to the liver. Portal hypertension is defined as a hepatic venous pressure gradient gr ...

develops. These blood vessels are engorged more than normal, and in the worst cases may partially obstruct the esophagus. These blood vessels develop as part of a collateral circulation that occurs to drain blood from the

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

as a result of

, usually as a result of

liver disease Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common. Signs and symptoms Some of the sig ...

s such as

cirrhosis Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repai ...

. This collateral circulation occurs because the lower part of the esophagus drains into the left gastric vein, which is a branch of the portal vein. Because of the extensive venous plexus that exists between this vein and other veins, if portal hypertension occurs, the direction of blood drainage in this vein may reverse, with blood draining from the portal venous system, through the plexus. Veins in the plexus may engorge and lead to varices. Esophageal varices often do not have symptoms until they rupture. A ruptured varix is considered a medical emergency because varices can bleed a lot. A bleeding varix may cause a person to vomit blood, or suffer

shock Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emerge ...

. To deal with a ruptured varix, a band may be placed around the bleeding blood vessel, or a small amount of a clotting agent may be injected near the bleed. A surgeon may also try to use a small inflatable balloon to apply pressure to stop the wound.

IV fluids Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

and

blood product A blood product is any therapeutic substance prepared from human blood. This includes whole blood; blood components; and plasma derivatives. Whole blood is not commonly used in transfusion medicine. Blood components include: red blood cell concen ...

s may be given in order to prevent

hypovolemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the los ...

from excess blood loss.

Motility disorders

Several disorders affect the motility of food as it travels down the esophagus. This can cause difficult swallowing, called

, or painful swallowing, called

Achalasia Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esoph ...

refers to a failure of the lower esophageal sphincter to relax properly, and generally develops later in life. This leads to progressive enlargement of the esophagus, and possibly eventual

megaesophagus Megaesophagus, also known as esophageal dilatation, is a disorder of the esophagus in humans and other mammals, whereby the esophagus becomes abnormally enlarged. Megaesophagus may be caused by any disease which causes the muscles of the esophagus ...

. A

nutcracker esophagus Nutcracker esophagus, Jackhammer esophagus, or hypercontractile 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 ...

refers to swallowing that can be extremely painful.

Diffuse esophageal spasm Diffuse esophageal spasm (DES), also known as distal esophageal spasm, is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation. In some cases, it may cause sym ...

is a spasm of the esophagus that can be one cause of chest pain. Such

referred pain Referred pain, also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in th ...

to the wall of the upper chest is quite common in esophageal conditions. Sclerosis of the esophagus, such as with

systemic sclerosis Systemic scleroderma, or systemic sclerosis, is an autoimmune rheumatic disease characterised by excessive production and accumulation of collagen, called fibrosis, in the skin and internal organs and by injuries to small arteries. There are two m ...

or in

CREST syndrome CREST syndrome, also known as the limited cutaneous form of systemic sclerosis (lcSSc), is a multisystem connective tissue disorder. The acronym "CREST" refers to the five main features: calcinosis, Raynaud's phenomenon, esophageal dysmotility, s ...

may cause hardening of the walls of the esophagus and interfere with peristalsis.

Malformations

Esophageal stricture A benign esophageal stricture, or peptic stricture, is a narrowing or tightening of the esophagus that causes swallowing difficulties. Signs and symptoms Symptoms of esophageal strictures include heartburn, bitter or acid taste in the mouth, chok ...

s are usually benign and typically develop after a person has had

for many years. Other strictures may include

esophageal web Esophageal webs are thin membranes occurring anywhere along the esophagus. Presentation Its main symptoms are pain and difficulty in swallowing (dysphagia). Esophageal webs are thin membranes of normal esophageal tissue consisting of mucosa and ...

s (which can also be congenital) and damage to the esophagus by radiotherapy, corrosive ingestion, or eosinophilic esophagitis. A

Schatzki ring A Schatzki ring or Schatzki–Gary ring is a narrowing of the lower esophagus that can cause difficulty swallowing (dysphagia). The narrowing is caused by a ring of mucosal tissue (which lines the esophagus) or muscular tissue. A Schatzki ring is ...

is fibrosis at the gastro-esophageal junction. Strictures may also develop in chronic

anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, th ...

, and Plummer-Vinson syndrome. Two of the most common

congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

malformations affecting the esophagus are an

esophageal atresia Esophageal can refer to: * The esophagus * Esophageal arteries * Esophageal glands The esophageal glands are glands that are part of the digestive system of various animals, including humans. In humans Esophageal glands in humans are a part of a ...

where the esophagus ends in a blind sac instead of connecting to the stomach; and an esophageal fistula – an abnormal connection between the esophagus and the trachea. Both of these conditions usually occur together. These are found in about 1 in 3500 births. Half of these cases may be part of a

syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek σύνδρομον, meaning "concurrence". When a syndrome is paired ...

where other abnormalities are also present, particularly of the

limb Limb may refer to: Science and technology *Limb (anatomy), an appendage of a human or animal *Limb, a large or main branch of a tree *Limb, in astronomy, the curved edge of the apparent disk of a celestial body, e.g. lunar limb *Limb, in botany, ...

s. The other cases occur singly.

Imaging

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

of swallowed barium may be used to reveal the size and shape of the esophagus, and the presence of any masses. The esophagus may also be imaged using a flexible camera inserted into the esophagus, in a procedure called an

. If an endoscopy is used on the stomach, the camera will also have to pass through the esophagus. During an endoscopy, a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

may be taken. If cancer of the esophagus is being investigated, other methods, including a

, may also be used.

History

The word ''esophagus'' (

: ''oesophagus''), comes from the el, οἰσοφάγος () meaning ''gullet''. It derives from two roots ''(eosin)'' to carry and () to eat. The use of the word oesophagus, has been documented in anatomical literature since at least the time of

Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...

, who noted that "the oesophagus ... receives the greatest amount of what we consume." Its existence in other animals and its relationship with the

was documented by the

Roman Roman or Romans most often refers to: *Rome, the capital city of Italy *Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of ancient Rome *''Epistle to the Romans'', shortened to ''Romans'', a letter ...

naturalist

Pliny the Elder Gaius Plinius Secundus (AD 23/2479), called Pliny the Elder (), was a Roman author, naturalist and natural philosopher, and naval and army commander of the early Roman Empire, and a friend of the emperor Vespasian. He wrote the encyclopedic '' ...

(AD23–AD79), and the

peristaltic Peristalsis ( , ) is a radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an anterograde direction. Peristalsis is progression of coordinated contraction of involuntary circular muscles, which ...

contractions of the esophagus have been documented since at least the time of

Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...

. The first attempt at surgery on the esophagus focused in the neck, and was conducted in dogs by

Theodore Billroth Christian Albert Theodor Billroth (26 April 18296 February 1894) was a German surgeon and amateur musician. As a surgeon, he is generally regarded as the founding father of modern abdominal surgery. As a musician, he was a close friend and con ...

in 1871. In 1877

Czerny Czerny is a surname meaning "black" in some Slavic languages. It is one of many variant forms, including Czarny, Černý, Czernik, Cherney, and Čierny, among others. People Notable people with this surname include: *Adalbert Czerny (1863−1941 ...

carried out surgery in people. By 1908, an operation had been performed by Voeckler to remove the esophagus, and in 1933 the first surgical removal of parts of the lower esophagus, (to control

), had been conducted. The

Nissen fundoplication A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical thera ...

, in which the stomach is wrapped around the lower

esophageal sphincter The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an Organ (anatomy), organ in vertebrates through which food passes, aided by Peristalsis, peristaltic contracti ...

to stimulate its function and control

, was first conducted by

Rudolph Nissen Rudolph Nissen (sometimes spelled Rudolf Nissen) (September 5, 1896 – January 22, 1981) was a surgeon who chaired surgery departments in Turkey, the United States and Switzerland. The Nissen fundoplication, a surgical procedure for the treatment ...

in 1955.

Other animals

Vertebrates

tetrapod Tetrapods (; ) are four-limbed vertebrate animals constituting the superclass Tetrapoda (). It includes extant and extinct amphibians, sauropsids ( reptiles, including dinosaurs and therefore birds) and synapsids (pelycosaurs, extinct theraps ...

s, the pharynx is much shorter, and the esophagus correspondingly longer, than in fish. In the majority of vertebrates, the esophagus is simply a connecting tube, but in some

birds Birds are a group of warm-blooded vertebrates constituting the class Aves (), characterised by feathers, toothless beaked jaws, the laying of hard-shelled eggs, a high metabolic rate, a four-chambered heart, and a strong yet lightweigh ...

, which regurgitate components to feed their young, it is extended towards the lower end to form a

crop A crop is a plant that can be grown and harvested extensively for profit or subsistence. When the plants of the same kind are cultivated at one place on a large scale, it is called a crop. Most crops are cultivated in agriculture or hydroponic ...

for storing food before it enters the true stomach. In

ruminant Ruminants (suborder Ruminantia) are ungulate, hoofed herbivorous grazing or browsing mammals that are able to acquire nutrients from plant-based food by Enteric fermentation, fermenting it in a specialized stomach prior to digestion, principally ...

s, animals with four stomachs, a groove called the ''sulcus reticuli'' is often found in the esophagus, allowing milk to drain directly into the hind stomach, the

abomasum The abomasum, also known as the maw,The Cham ...

. In the

horse The horse (''Equus ferus caballus'') is a domesticated, one-toed, hoofed mammal. It belongs to the taxonomic family Equidae and is one of two extant subspecies of ''Equus ferus''. The horse has evolved over the past 45 to 55 million y ...

the esophagus is about in length, and carries food to the stomach. A muscular ring, called the cardiac sphincter, connects the stomach to the esophagus. This sphincter is very well developed in horses. This and the oblique angle at which the esophagus connects to the stomach explains why horses cannot

vomit Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteriti ...

. The esophagus is also the area of the digestive tract where horses may have the condition known as choke. The esophagus of

snake Snakes are elongated, Limbless vertebrate, limbless, carnivore, carnivorous reptiles of the suborder Serpentes . Like all other Squamata, squamates, snakes are ectothermic, amniote vertebrates covered in overlapping Scale (zoology), scales. Ma ...

s is remarkable for the distension it undergoes when swallowing prey. In most fish, the esophagus is extremely short, primarily due to the length of the pharynx (which is associated with the

gill A gill () is a respiratory organ that many aquatic organisms use to extract dissolved oxygen from water and to excrete carbon dioxide. The gills of some species, such as hermit crabs, have adapted to allow respiration on land provided they are ...

s). However, some fish, including

lamprey Lampreys (sometimes inaccurately called lamprey eels) are an ancient extant lineage of jawless fish of the order Petromyzontiformes , placed in the superclass Cyclostomata. The adult lamprey may be characterized by a toothed, funnel-like s ...

chimaera Chimaeras are cartilaginous fish in the order Chimaeriformes , known informally as ghost sharks, rat fish, spookfish, or rabbit fish; the last three names are not to be confused with rattails, Opisthoproctidae, or Siganidae, respectively. At ...

s, and

lungfish Lungfish are freshwater vertebrates belonging to the order Dipnoi. Lungfish are best known for retaining ancestral characteristics within the Osteichthyes, including the ability to breathe air, and ancestral structures within Sarcopterygii, i ...

, have no true stomach, so that the esophagus effectively runs from the pharynx directly to the

, and is therefore somewhat longer. In many vertebrates, the esophagus is lined by

without glands. In fish, the esophagus is often lined with

columnar epithelium Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellular ...

, and in

amphibian Amphibians are tetrapod, four-limbed and ectothermic vertebrates of the Class (biology), class Amphibia. All living amphibians belong to the group Lissamphibia. They inhabit a wide variety of habitats, with most species living within terres ...

shark Sharks are a group of elasmobranch fish characterized by a cartilaginous skeleton, five to seven gill slits on the sides of the head, and pectoral fins that are not fused to the head. Modern sharks are classified within the clade Selachimo ...

s and

rays Ray may refer to: Fish * Ray (fish), any cartilaginous fish of the superorder Batoidea * Ray (fish fin anatomy), a bony or horny spine on a fin Science and mathematics * Ray (geometry), half of a line proceeding from an initial point * Ray (gra ...

, the esophageal epithelium is

cilia The cilium, plural cilia (), is a membrane-bound organelle found on most types of eukaryotic cell, and certain microorganisms known as ciliates. Cilia are absent in bacteria and archaea. The cilium has the shape of a slender threadlike projecti ...

ted, helping to wash food along, in addition to the action of muscular peristalsis. In addition, in the

bat Bats are mammals of the order Chiroptera.''cheir'', "hand" and πτερόν''pteron'', "wing". With their forelimbs adapted as wings, they are the only mammals capable of true and sustained flight. Bats are more agile in flight than most bi ...

Plecotus auritus ''Plecotus'' is a genus of vesper bat, commonly called long-eared bats. They are found throughout Eurasia and northern Africa. Many species in the genus have only been described and recognized in recent years. Species Genus ''Plecotus'' – lon ...

'', fish and some amphibians, glands secreting

pepsinogen Pepsin is an endopeptidase that breaks down proteins into smaller peptides. It is produced in the gastric chief cells of the stomach lining and is one of the main digestive enzymes in the digestive systems of humans and many other animals, whe ...

have been found. The muscle of the esophagus in many mammals is initially striated but then becomes smooth muscle in the caudal third or so. In

canines Canine may refer to: Zoology and anatomy * a dog-like Canid animal in the subfamily Caninae ** ''Canis'', a genus including dogs, wolves, coyotes, and jackals ** Dog, the domestic dog * Canine tooth, in mammalian oral anatomy People with the surn ...

and

s, however, it is entirely striated to allow regurgitation to feed young (canines) or regurgitation to chew cud (ruminants). It is entirely smooth muscle in amphibians, reptiles and birds. Contrary to popular belief, an adult

human body The human body is the structure of a Human, human being. It is composed of many different types of Cell (biology), cells that together create Tissue (biology), tissues and subsequently organ systems. They ensure homeostasis and the life, viabi ...

would not be able to pass through the esophagus of a

whale Whales are a widely distributed and diverse group of fully aquatic placental marine mammals. As an informal and colloquial grouping, they correspond to large members of the infraorder Cetacea, i.e. all cetaceans apart from dolphins and ...

, which generally measures less than in diameter, although in larger

baleen whale Baleen whales (systematic name Mysticeti), also known as whalebone whales, are a parvorder of carnivorous marine mammals of the infraorder Cetacea (whales, dolphins and porpoises) which use keratinaceous baleen plates (or "whalebone") in their ...

s it may be up to when fully distended.

Invertebrates

A structure with the same name is often found in invertebrates, including

mollusc Mollusca is the second-largest phylum of invertebrate animals after the Arthropoda, the members of which are known as molluscs or mollusks (). Around 85,000 extant species of molluscs are recognized. The number of fossil species is esti ...

s and

arthropod Arthropods (, (gen. ποδός)) are invertebrate animals with an exoskeleton, a Segmentation (biology), segmented body, and paired jointed appendages. Arthropods form the phylum Arthropoda. They are distinguished by their jointed limbs and Arth ...

s, connecting the oral cavity with the stomach. In terms of the digestive system of snails and slugs, the mouth opens into an esophagus, which connects to the stomach. Because of

torsion Torsion may refer to: Science * Torsion (mechanics), the twisting of an object due to an applied torque * Torsion of spacetime, the field used in Einstein–Cartan theory and ** Alternatives to general relativity * Torsion angle, in chemistry Bio ...

, which is the rotation of the main body of the animal during larval development, the esophagus usually passes around the stomach, and opens into its back, furthest from the mouth. In species that have undergone de-torsion, however, the esophagus may open into the anterior of the stomach, which is the reverse of the usual gastropod arrangement. There is an extensive

rostrum Rostrum may refer to: * Any kind of a platform for a speaker: **dais **pulpit * Rostrum (anatomy), a beak, or anatomical structure resembling a beak, as in the mouthparts of many sucking insects * Rostrum (ship), a form of bow on naval ships * Ros ...

at the front of the esophagus in all carnivorous snails and slugs. In the freshwater snail species ''

Tarebia granifera ''Tarebia granifera'', common name (in the aquarium industry) the quilted melania, is a species of freshwater snail with an operculum, an aquatic gastropod mollusk in the family Thiaridae. MolluscaBase eds. (2020). MolluscaBase. Tarebia grani ...

'', the brood pouch is above the esophagus.Appleton C. C., Forbes A. T.& Demetriades N. T. (2009)
"The occurrence, bionomics and potential impacts of the invasive freshwater snail ''Tarebia granifera'' (Lamarck, 1822) (Gastropoda: Thiaridae) in South Africa"
. ''Zoologische Mededelingen'' 83. In the

cephalopod A cephalopod is any member of the molluscan class Cephalopoda (Greek plural , ; "head-feet") such as a squid, octopus, cuttlefish, or nautilus. These exclusively marine animals are characterized by bilateral body symmetry, a prominent head ...

s, the brain often surrounds the esophagus.

References

External links

{{Authority control Digestive system Thorax (human anatomy) Organs (anatomy) Human head and neck Abdomen

Structure

Sphincters

Nerve supply

Gastro-esophageal junction

Microanatomy

Development

Function

Swallowing

Reducing gastric reflux

Gene and protein expression

Clinical significance

Inflammation

Barrett's esophagus

Cancer

Varices

Motility disorders

Malformations

Imaging

History

Other animals

Vertebrates

Invertebrates

See also

References

External links