Everything You Need to Know About Your Esophagus

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The esophagus is a muscular tube that carries food and liquids from the throat to the stomach. The esophagus runs through the middle of the chest cavity and has two circular muscles called sphincters that open and close the ends.

The primary function of the esophagus is to transport food from your throat to your stomach. Many conditions can affect the esophagus, one of the most common of which is acid reflux and GERD. Other potentially serious conditions include esophageal varices associated with advanced liver disease and esophageal cancer.

This article explains the anatomy and function of the esophagus, including medical conditions that can affect this digestive organ. It also describes how esophageal disorders are diagnosed and things you can do to keep your esophagus healthy.

Man with tongue depressor in his mouth
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Anatomy of the Esophagus 

The esophagus is a muscular tube about 9 to 10 inches long in adults that starts at the pharynx (throat) and ends at the stomach.

As it descends from the throat, sandwiched between the spine and the trachea (windpipe), the esophagus passes through a thin but strong muscle called the diaphragm that separates the chest and abdominal cavities.

There are two sphincters at the top and bottom of the esophagus:

  • The upper esophageal sphincter (UES) prevents food and liquids from entering the windpipe. The UES can open and close voluntarily during swallowing but can also open and close involuntarily, such as during burping or vomiting.
  • The lower esophageal sphincter (LES) is an involuntary muscle that allows food to pass from the esophagus to the stomach. It also prevents stomach acid and food from backflowing into the esophagus.

What Does the Esophagus Do?

The primary role of the esophagus is to transport the food from your throat to your stomach. The process can be described as follows:

  1. Once you chew and swallow food, the food enters the pharynx where voluntary muscle contractions (narrowing) force it downward.
  2. The swallowing relaxes the UES, allowing food to enter the esophagus.
  3. The food is eased down the esophagus by involuntary, wave-like contractions called peristalsis.
  4. When the food reaches the bottom of the esophagus, the LES relaxes, allowing food to enter the stomach.
  5. After food enters the stomach, the LES closes to prevent the backflow of stomach acid.

With vomiting, the contractions are reversed, forcing the contents of the stomach into the esophagus and out of the mouth in violent bursts. During vomiting, a flap at the top of the trachea, called the epiglottis, will automatically shut to keep the vomit from entering the airways and lungs.

When functioning normally, the LES can keep stomach acids inside the stomach. If stomach acid leaks into the esophagus, referred to as acid reflux, the UES should remain shut to prevent acid from entering the mouth, throat, and nasal passages.

Associated Conditions 

Many medical conditions can affect the structure or function of the esophagus. Some of the more common include:

  • Gastroesophageal reflux disorder (GERD): This is a chronic form of acid reflux closely linked to obesity, smoking, alcohol, and poor diet. Some causes of GERD are idiopathic (of unknown origins). Genetics are also thought to play a part.
  • Laryngopharyngeal reflux: This occurs when the UES fails to work, worsening acid reflux by allowing stomach acid to pool in the throat. The risk factors are the same as for GERD.
  • Hiatal hernia: This happens when the esophagus gets displaced as it passes through the diaphragm. This causes bulging that can stress the LES and allow acid to backflow.
  • Esophageal dysmotility: These are functional problems affecting peristalsis. Examples include nutcracker esophagus, which causes difficulty swallowing, and jackhammer esophagus, which causes violent, long-lasting spasms.
  • Achalasia: This is another dysmotility disorder in which the LES does not relax, preventing food from passing into the stomach. If this happens, food and drink can backflow into the esophagus, causing chest pain, vomiting, and choking.
  • Perforated esophagus: This is a severe tear of the esophagus caused by a perforating wound (like a chest stab), medical procedures (like upper endoscopy), or swallowing caustic substances or sharp objects. Mallory-Weiss tears are deep tears that can occur with violent vomiting.
  • Barrett's esophagus: This is a type of precancer affecting tissues lining the esophagus, often caused by long-standing GERD.
  • Esophageal varices: These are swollen and misshapen veins of the esophagus associated with cirrhosis of the liver which can rupture and bleed.
  • Esophageal cancer: This is a rare cancer with a generally poor prognosis. There are two major types: squamous cell cancer closely linked to heavy smoking and drinking and adenocarcinoma most often seen in people with longstanding GERD.

Signs and Symptoms of Esophageal Disorders

There are signs and symptoms common with a wide variety of esophageal disorders. Those characteristic of esophageal dysfunction and disease include:

Heartburn

Heartburn is the consequence of acid reflux. The terms "heartburn" and "acid reflux" are often used interchangeably, but they actually mean different things.

Acid reflux is the backflow of stomach contents into the esophagus. Heartburn is the feeling that acid reflux causes, characterized by symptoms like:

  • A mild to severe burning sensation in the mid-chest
  • A burning sensation in the throat
  • A bitter sensation in the mouth
  • Burning that worsens after meals or when lying down

Dysphagia

Dysphagia is the term that describes difficulty swallowing. It can occur in the upper esophagus (oropharyngeal dysphagia) or the middle or lower esophagus (esophageal dysphagia).

Symptoms of oropharyngeal dysphagia include:

  • Coughing, choking, gagging, or drooling when eating or drinking
  • Hoarseness
  • An inability to initiate swallowing
  • A feeling that something is stuck in your throat
  • Nasal regurgitation

Esophageal dysphagia can cause symptoms like:

  • Mid-chest pain or pressure
  • Feeling like food is stuck in your chest after eating
  • Coughing
  • Heartburn
  • Regurgitation

Oropharyngeal dysphagia commonly occurs with esophageal dysphagia, and vice versa.

Odynophagia

Odynophagia is a term describing pain with swallowing. It can be caused by swallowing toxic materials that burn the esophagus, an injury of the upper esophagus, or certain infections.

Symptoms of odynophagia include:

  • A dull, burning pain or sharp, stabbing pain in the throat or mid-chest when swallowing
  • Pain that gets worse when swallowing dry food
  • Dehydration from the reduced fluid intake
  • Unintended weight loss due to reduced food intake

Esophageal Spasms

Esophageal spasms are rapid and sometimes violent contractions of the esophagus commonly seen with conditions like GERD and achalasia.

Symptoms of esophageal spasms include:

  • Squeezing pain in the mid-chest (easily confused with angina)
  • Dysphagia
  • Odynophagia
  • A feeling that an object is stuck in your throat
  • Vomiting

Diagnostic Tests

A number of different tests may be performed to evaluate the esophagus and upper gastrointestinal (GI) tract, including:

  • Upper GI series: This is a series of X-rays of the pharynx, esophagus, and stomach. A solution containing barium may be swallowed to improve the contrast of the X-ray image, referred to as a barium swallow radiograph.
  • Upper GI endoscopy: This imaging technique involves the passage of a tube outfitted with a lighted camera into your mouth and esophagus. If abnormalities are seen on the video monitor, a biopsy can be performed by threading special equipment through the neck of the tube.
  • Esophageal pH monitoring: This involves the passage of a probe into the esophagus to measure the pH (acidity or alkalinity) of the esophagus.
  • Esophageal manometry: This test evaluates motility disorders of the esophagus. It involves the passage of a pressure-sensitive tube into your nose, throat, and esophagus to measure peristalsis contractions.
  • Endoscopic ultrasound: This involves the insertion of a device called a sonographic transducer through the mouth and into the esophagus to visualize the esophagus. Ultrasound is a non-invasive imaging tool that can create highly detailed images with reflected sound waves.
  • Esophageal impedance: This test measures the amount and type of reflux in the esophagus, It is performed by passing a tube through the nose and into the esophagus, which is kept in place for 20 to 24 hours.
  • EdnoFLIP: This test combines upper GI endoscopy with esophageal impedance to achieve a more insightful evaluation of esophageal motility.

How to Keep Your Esophagus Health

You can't always prevent esophageal disorders, but there are ways to reduce the risk. This is especially true of conditions like GERD, hiatal hernia, and esophageal cancer which are heavily influenced by lifestyle.

Here are some things you can do:

  • Lose weight: Being overweight or having obesity increases the risk of acid reflux and hiatal hernia. The reduction of abdominal obesity with a low-fat diet and exercise can help.
  • Alter your diet: If you are prone to reflux, avoid carbonated drinks and foods that are acidic. spicy, fatty, fried, processed, or high in caffeine. Instead, focus on blander foods that are more easily digested.
  • Change your eating habits: Eat smaller meals several times a day (rather than three big meals) to reduce stress on the stomach. Also, eat sitting upright rather than slouched so that food passes more easily into the stomach. Do not lie down immediately after eating.
  • Cut back on alcohol: As a depressant, alcohol can relax the LES and increase the risk of acid reflux. Like caffeine, it also stimulates the production of stomach acid.
  • Stop smoking: Cigarette smoke directly damages the esophagus and promotes or worsens almost all conditions affecting the esophagus. Ask your healthcare provider about smoking cessation aids that can help.
  • Change your sleep habits: To reduce the risk of acid reflux, avoid eating food at least an hour before bedtime. Raising your head with pillows can also prevent the backflow of acid while you are sleeping.

Summary

The esophagus is the muscular tube that transfers food from the mouth to the stomach. Damage or dysfunction of the organ can lead to chest pain, difficulty swallowing, heartburn, or vomiting.

Conditions affecting the esophagus range from functional disorders like GERD and achalasia to medical concerns like hiatal hernia, esophageal varices, and esophageal cancer. Some of these conditions can be avoided by quitting cigarettes, minimizing alcohol intake, and maintaining a healthy weight.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."