The upper 1/3 is striated and the lower 2/3 is smooth muscle.
The most important function is to provide the transport of food between the two ends. Dysphagia occurs when transit function is impaired.
Thanks to its lower sphincter, it prevents the return of food. If the return cannot be prevented, gastroesophageal reflux, which is the most common disease of the esophagus, occurs.
Symptoms
1- Dysphagia
(For full details of dysphagia, Please click here)
• It is almost always associated with dysphagia.
• Conditions that cause mucosal destruction in the esophagus: reflux esophagitis (most common), infectious esophagitis (especially candidiasis) and pill esophagitis cause odynophagia.
In the patient with odynophagia, the primary investigation should be endoscopy.
• It is the most common symptom related to the esophagus.
• It usually occurs after meals and when lying on the back.
• It is the most specific symptom of gastroesophageal reflux (GER) disease.
• Therefore, if there are no warning signs, a diagnosis can be made based on the history and empirical treatment can be performed.
• It can be seen immediately (especially oropharyngeal dysphagia) or delayed after swallowing.
• Substernal pain and pressure sensation suggestive of angina pectoris may be felt in some esophageal diseases.
• Differences of esophageal chest pain from angina pectoris:
It is long term.
It is closely related to food intake.
Other esophageal symptoms may be observed together
It has nothing to do with effort.
• The most common cause of non-cardiac chest pain is GERD.
• Diffuse esophageal spasm can also be seen in motility diseases such as hypertensive esophagus (nutcracker) and achalasia.
• If a motility disorder or stenosis is suspected in a patient presenting with dysphagia, it should be the first examination to be selected.
• It is superior to endoscopy in evaluating the following esophageal pathologies.
Esophageal strictures
Motility disorders
External pressure on the esophagus
Esophageal diverticulum
Tracheoesophageal fistulas
Odynophagia should be the first examination to be selected in cases where malignancy is suspected, Barrett's esophagus investigation, bleeding is suspected, biopsy and interventional procedure is required.
• It is also used for the treatment of dilating benign or malignant strictures in the esophagus with balloon and stopping bleeding.
• It is especially useful in the diagnosis and differential diagnosis of achalasia, diffuse esophageal spasm and scleroderma.
• High resolution impedance (resistance to transit) manometry; Intraesophageal transit demonstrates lower and upper esophageal pressures with higher sensitivity and specificity.
• It is the most sensitive method to detect GERD.
• In combination with intraluminal impedance, more objective information can be provided regarding the property of the refluxing material and the duration of its stay in the lumen.
2- Odynophagia (painful swallowing difficulty)
It is a sharp pain sensation in the substernal region with dysphagia during swallowing and restricting oral intake. It should always suggest an organic disease.• It is almost always associated with dysphagia.
• Conditions that cause mucosal destruction in the esophagus: reflux esophagitis (most common), infectious esophagitis (especially candidiasis) and pill esophagitis cause odynophagia.
In the patient with odynophagia, the primary investigation should be endoscopy.
3- Heartburn
• It is a burning sensation that occurs in the substernal region as a result of reflux of stomach contents into the esophagus and sometimes spreads upwards to the throat.• It is the most common symptom related to the esophagus.
• It usually occurs after meals and when lying on the back.
• It is the most specific symptom of gastroesophageal reflux (GER) disease.
• Therefore, if there are no warning signs, a diagnosis can be made based on the history and empirical treatment can be performed.
4- Regurgitation
• It is the spontaneous introduction of foodstuffs into the oropharynx or mouth.• It can be seen immediately (especially oropharyngeal dysphagia) or delayed after swallowing.
5- Chest Pain
• The most common organ causing non-cardiac chest pain is the esophagus.• Substernal pain and pressure sensation suggestive of angina pectoris may be felt in some esophageal diseases.
• Differences of esophageal chest pain from angina pectoris:
It is long term.
It is closely related to food intake.
Other esophageal symptoms may be observed together
It has nothing to do with effort.
• The most common cause of non-cardiac chest pain is GERD.
• Diffuse esophageal spasm can also be seen in motility diseases such as hypertensive esophagus (nutcracker) and achalasia.
Diagnostic Methods
1-Medicated (Barium) Esophageal X-ray
• It is used to investigate structural and motor dysfunctions of the esophagus.• If a motility disorder or stenosis is suspected in a patient presenting with dysphagia, it should be the first examination to be selected.
• It is superior to endoscopy in evaluating the following esophageal pathologies.
Esophageal strictures
Motility disorders
External pressure on the esophagus
Esophageal diverticulum
Tracheoesophageal fistulas
2- Esophagoscopy
• It is the most valuable method in the diagnosis of mucosal and space-occupying lesions of the esophagus.Odynophagia should be the first examination to be selected in cases where malignancy is suspected, Barrett's esophagus investigation, bleeding is suspected, biopsy and interventional procedure is required.
• It is also used for the treatment of dilating benign or malignant strictures in the esophagus with balloon and stopping bleeding.
3- Endoscopic Ultrasonography (Endosonography, EUS)
• It is the most valuable method for evaluating submucosal lesions and local staging of esophageal tumors.4- Esophageal Manometry
• It is used to detect esophageal contractions and pressure changes in patients with suspected motility disorder.• It is especially useful in the diagnosis and differential diagnosis of achalasia, diffuse esophageal spasm and scleroderma.
• High resolution impedance (resistance to transit) manometry; Intraesophageal transit demonstrates lower and upper esophageal pressures with higher sensitivity and specificity.
5- Esophageal pH Monitoring
• 24-48 hours monitoring of esophageal lower end pH with the help of specially developed catheters or wireless transmitter.• It is the most sensitive method to detect GERD.
• In combination with intraluminal impedance, more objective information can be provided regarding the property of the refluxing material and the duration of its stay in the lumen.