Tuesday 1 September 2015

Esophagus: Facts, Functions & Diseases

by Alina Bradford

If the mouth is the gateway to the body, then the esophagus is a highway for food and drink to travel along to make it to the stomach. This body part has a very simple function, but can have many disorders. 


The esophagus is a tube that connects the throat (pharynx) and the stomach. It is about 8 inches (20 centimeters) long. The esophagus isn’t just a hollow tube that food slips down like a water slide, though. The esophagus is made of muscles that contract to move food to the stomach. This process is called peristalsis, according to the Cleveland Clinic.
At the top of the esophagus is a band of muscle called the upper esophageal sphincter. Another band of muscle, the lower esophageal sphincter is at the bottom of the tube, slightly above the stomach. When a person swallows, these sphincters relax so food can pass into the stomach. When not in use, they contract so food and stomach acid do not flow back up the esophagus.

Conditions and diseases

As a person ages, the sphincters weaken, making some people more prone to backflow of 
acid from the stomach, a condition called gastroesophageal reflux disease (GERD). GERD can cause severe damage to the esophagus, according to the National Library of Medicine. 
“GERD is due to the reflux of acid contents of the stomach that get refluxed up into the esophagus," Dr. Lisa Ganjhu, a clinical assistant professor of medicine and gastroenterologist at NYU Langone Medical Center, told Live Science. "Acid is not meant to be in the esophagus so the symptoms of that may be a burning sensation in the chest, the pain can be so intense that it feels like a heart attack. It is always best to seek medical attention if you are having those symptoms.” 
Some people are sensitive to certain foods that lower the pressure of the lower esophageal sphincter and this allows the acid to wash up into the esophagus. Anxiety also increases the sensitivity of the esophagus so the sensation is more severe. 
GERD can also cause esophagus ulcers. An ulcer is an open sore that, in this case, is located in the esophagus. Some symptoms are pain, nausea, heartburn and chest pain, according to the University of Minnesota Medical Center.
Barrett’s esophagus is a condition that may occur when the lining of the esophagus changes to be more like the lining of the intestine, according to The National Institute of Diabetes and Digestive and Kidney Diseases. This condition can turn into a rare cancer called esophageal adenocarcinoma.​ There is no known cause of this disorder, but doctors have found that those with GERD are more likely to get Barrett’s.
According to the American Cancer Society, esophageal cancer typically has no symptoms until it is advanced. Symptoms include difficulty swallowing (also called dysphagia), chest pain and weight loss. 
Esophagus spasms, also called "nutcracker esophagus," are unexplained muscle contractions of the esophagus that can be quite painful, according to the Mayo Clinic. One of the symptoms is severe, sudden chest pain and, if the spasms are frequent, they can prevent swallowing.
Another disorder that can prevent swallowing is motor neuron disease. Motor neuron diseases (MND) affecting millions of Americans, with over 100,000 diagnosed annually. Between 80 to 95 percent of people living with MND experience some loss of speech and swallowing before they die, according to a press release by Johns Hopkins. “The disease really is characterized by, and for the most part, normal mental function, normal sensation," said Dr. Nicholas Maragakis, co-medical director of The Johns Hopkins ALS Clinic. "Patients gradually get weaker, over time. Unlike stroke, it’s not a disease that happens overnight.” 

Promoting good esophagus health

Ganjhu gave these tips for the best way to prevent reflux of food and acid into the esophagus and ways to help treat GERD:
  • Eat small meals so that the food does not sit in the stomach and instead moves on to the small bowel to be further digested. 
  • Try acid-blocking medications.
  • Avoid or reduce consumption of foods and beverages that contain caffeine, chocolate, peppermint, spearmint and alcohol.
  • Avoid all carbonated drinks.
  • Cut down on fatty foods.
  • Eat a diet rich in fruits and vegetables, although it may best to avoid acidic vegetables and fruits (such as oranges, lemons, grapefruit, pineapple and tomatoes) if they bother you.
  • Quit smoking. 
  • Overweight people should try to diet and exercise to lose weight. A starting goal is to lose 5 to 10 percent of your present weight.
  • People with GERD should avoid wearing tight clothing, particularly around the abdomen.
  • If possible, GERD patients should avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin, Advil) or naproxen (Aleve).
  • After meals, take a walk or stay upright.
  • Avoid bedtime snacks. In general, do not eat for at least two hours before bedtime.
  • When going to bed, try lying on the left side rather than the right side. The stomach is located higher than the esophagus while sleeping on the right side, which can put pressure on the lower esophageal sphincter (LES), increasing the risk for fluid backup.
  • Sleep in a tilted position to help keep acid in the stomach at night. To do this, raise the bed at an angle using 4- to 6-inch (10 to 15 centimeters) blocks under the head of the bed. Use a wedge support to elevate the top half of your body. Extra pillows that only raise the head actually increase the risk for reflux.
Additional resources
  • Society of Thoracic Surgeons: Barrett’s Esophagus
  • Mayo Clinic: Dysphagia
  • National Institute of Neurological Disorders and Stroke: Motor Neuron Diseases Fact Sheet

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