Esophagus
INTRODUCTION
Recent advances in laparoscopic video procedures, the development of modern diagnostic
methods and improved surgical approach, have enabled in recent years a safer
management with less recovery time in patients with surgical diseases of the esophagus.
The proper medical history remains the fundamental pillar for the diagnosis, the data must
be recorded thoroughly, taking into account the esophageal physiology, reaching the correct
elaboration of it with diagnostic precision up to 80%.
The esophagus is a segment of the digestive tract, fibromuscular, 25 cm in length, which
binds the pharynx to the stomach and serves for the passage of food; Originating at the level
of the sixth cervical vertebra, it crosses the cervical region (behind the trachea), thorax
(behind the aortic arc and the left bronchio) then right side and anterior side of the aorta and
transposes the diaphragm through the esophageal hiatus, running 2 to 4 cm below it in the
abdomen.
It is fixed in the pharynx and stomach in the distal region and also by fibromuscular tracts
that unite it to the trachea. It is soft; it is easily distinguished and mobilizes vertically and
laterally.
Anatomically there are three narrowing:
1. At the level of the Cricoid cartilage (pharynghagic sphincter), 15 to 16 cm of the
dental arcade.
2. At the aortic arc level, at 27 cm from the arch.
3. At the level of the esophageal hiatus (gastroesophageal sphincter), approximately 40
to 42 cm from the dental arch.
The musculature of the upper third of the esophagus is striated and the rest is smooth. The
mucous layer is strong, with stratified squamous epithelium, externally it lacks serous.
The irrigation of the esophagus is important in the different segments, fundamentally in
charge of the thyroid arteries in the cervical region, the intercostal and bronchial arteries and
branches of the aorta in the thoracic region, as well as the phrenic arteries and branches of
the left gastric in the distal and abdominal portion of the esophagus.
The innervation of the esophagus comes from the pneumogastric and great sympathetic
nerves. The intrinsic innervation corresponds to the submucosal plexuses of Meissner and
Auerbach; all of them intimately related.
The esophagus maintains a coordinated and complex peristaltic activity to transfer food from
the oral cavity to the stomach, with sphincters (cricopharyngeal and gastroesophageal) at
whose level much higher pressures are evident. Esophageal manometry allows accurate
pressure records and study of the characteristics of the sphincters; of special importance is
the LES (lower esophageal sphincter), whose normal pressure is 10 to 25 mmHg.
Endoscopically, the esophagus begins on average 17 cm from the dental arch, at 27 cm,
there is compression of the aortic arch and left bronchus and at 42 cm (35 to 50 cm
depending on the size of the individual), and the Z line is found, sharp demarcation of the
esophageal and gastric mucosa.
1
,SYMPTOMS:
➔ Dysphagia: difficulty swallowing (passing food)
➔ Odynophagia: pain when swallowing
➔ Pyrosis: substernal itching or burning
➔ Regurgitation: food returns from the stomach to the mouth. Associated with
movements. Being from the stomach theoretically it is not a symptom of the
esophagus
◆ Pseudoregurgitation: the food returns from the esophagus to the mouth, this
would be the correct term.
➔ Sialorrhea: excessive saliva production
➔ Halitosis: bad breath caused by food retained in the esophagus
➔ Weight Loss
➔ Night cough
➔ Hoarseness
DYSPHAGIA
The term dysphagia comes from the Greek dís (bad) and phagia (to eat) and is defined as
the difficulty or impossibility of swallowing, which makes it essential to relate the
symptom to swallowing.
The patient can express this difficulty at the beginning of swallowing or by the stopping of the
swallowed food at the neck area or some retrosternal point.
Dysphagia is the pathophysiological expression of a dysfunction in the transport of the food
bolus, whether of a mechanical or functional nature.
The interrogation should be oriented to investigate:
Dysphagia from the clinical point of view is classified in oropharyngeal dysphagia and
esophageal dysphagia.
● The oropharyngeal dysphagia is the expression of the penetration of the food
bolus from the oral cavity to the proximal esophagus, which is why it is also called
penetration dysphagia. The difficulty is located in the throat.
2
, ● The esophageal dysphagia indicates impaired transport of the bolus along the
esophagus and the lower esophageal sphincter, which is why it is called transport
dysphagia. This is what is actually known as dysphagia
The causes of esophageal dysphagia are varied and can be classified as follows:
ANAMNESIS OF ESOPHAGEAL DYSPHAGIA
● Start time: since when did it start and how did it start?
● Type of food that causes it: liquid, semi-liquid, semi-solid or solid
● Evolution: if it is episodic or permanent
● How can swallowing be made easier?
● Other accompanying or associated symptoms
● We are interested in knowing if this dysphagia is: DOMAIN TABLE
MECHANICAL (organic) FUNCTIONAL (motor)
➢ Short duration (months) ➢ Long duration (years)
➢ Gradual or abrupt beginning ➢ Gradual start
➢ Permanent (always, every time the patient ➢ Episodic (sometimes, often linked
eats) to emotional state)
➢ Logical sequence: first I get stuck with ➢ Paradoxical sequence: it is not
meat (solid) then ground meat (semi-solid), related to the consistency of the
puree (semi-liquid), water (liquid) and so on food
from solid to liquid ➢ Location: variable
➢ Location: fixed ➢ Swallowing maneuvers +
➢ Best example: ➢ Best example:
○ Esophageal cancer (tumor) ○ achalasia
○ cicatricial stenosis
3
INTRODUCTION
Recent advances in laparoscopic video procedures, the development of modern diagnostic
methods and improved surgical approach, have enabled in recent years a safer
management with less recovery time in patients with surgical diseases of the esophagus.
The proper medical history remains the fundamental pillar for the diagnosis, the data must
be recorded thoroughly, taking into account the esophageal physiology, reaching the correct
elaboration of it with diagnostic precision up to 80%.
The esophagus is a segment of the digestive tract, fibromuscular, 25 cm in length, which
binds the pharynx to the stomach and serves for the passage of food; Originating at the level
of the sixth cervical vertebra, it crosses the cervical region (behind the trachea), thorax
(behind the aortic arc and the left bronchio) then right side and anterior side of the aorta and
transposes the diaphragm through the esophageal hiatus, running 2 to 4 cm below it in the
abdomen.
It is fixed in the pharynx and stomach in the distal region and also by fibromuscular tracts
that unite it to the trachea. It is soft; it is easily distinguished and mobilizes vertically and
laterally.
Anatomically there are three narrowing:
1. At the level of the Cricoid cartilage (pharynghagic sphincter), 15 to 16 cm of the
dental arcade.
2. At the aortic arc level, at 27 cm from the arch.
3. At the level of the esophageal hiatus (gastroesophageal sphincter), approximately 40
to 42 cm from the dental arch.
The musculature of the upper third of the esophagus is striated and the rest is smooth. The
mucous layer is strong, with stratified squamous epithelium, externally it lacks serous.
The irrigation of the esophagus is important in the different segments, fundamentally in
charge of the thyroid arteries in the cervical region, the intercostal and bronchial arteries and
branches of the aorta in the thoracic region, as well as the phrenic arteries and branches of
the left gastric in the distal and abdominal portion of the esophagus.
The innervation of the esophagus comes from the pneumogastric and great sympathetic
nerves. The intrinsic innervation corresponds to the submucosal plexuses of Meissner and
Auerbach; all of them intimately related.
The esophagus maintains a coordinated and complex peristaltic activity to transfer food from
the oral cavity to the stomach, with sphincters (cricopharyngeal and gastroesophageal) at
whose level much higher pressures are evident. Esophageal manometry allows accurate
pressure records and study of the characteristics of the sphincters; of special importance is
the LES (lower esophageal sphincter), whose normal pressure is 10 to 25 mmHg.
Endoscopically, the esophagus begins on average 17 cm from the dental arch, at 27 cm,
there is compression of the aortic arch and left bronchus and at 42 cm (35 to 50 cm
depending on the size of the individual), and the Z line is found, sharp demarcation of the
esophageal and gastric mucosa.
1
,SYMPTOMS:
➔ Dysphagia: difficulty swallowing (passing food)
➔ Odynophagia: pain when swallowing
➔ Pyrosis: substernal itching or burning
➔ Regurgitation: food returns from the stomach to the mouth. Associated with
movements. Being from the stomach theoretically it is not a symptom of the
esophagus
◆ Pseudoregurgitation: the food returns from the esophagus to the mouth, this
would be the correct term.
➔ Sialorrhea: excessive saliva production
➔ Halitosis: bad breath caused by food retained in the esophagus
➔ Weight Loss
➔ Night cough
➔ Hoarseness
DYSPHAGIA
The term dysphagia comes from the Greek dís (bad) and phagia (to eat) and is defined as
the difficulty or impossibility of swallowing, which makes it essential to relate the
symptom to swallowing.
The patient can express this difficulty at the beginning of swallowing or by the stopping of the
swallowed food at the neck area or some retrosternal point.
Dysphagia is the pathophysiological expression of a dysfunction in the transport of the food
bolus, whether of a mechanical or functional nature.
The interrogation should be oriented to investigate:
Dysphagia from the clinical point of view is classified in oropharyngeal dysphagia and
esophageal dysphagia.
● The oropharyngeal dysphagia is the expression of the penetration of the food
bolus from the oral cavity to the proximal esophagus, which is why it is also called
penetration dysphagia. The difficulty is located in the throat.
2
, ● The esophageal dysphagia indicates impaired transport of the bolus along the
esophagus and the lower esophageal sphincter, which is why it is called transport
dysphagia. This is what is actually known as dysphagia
The causes of esophageal dysphagia are varied and can be classified as follows:
ANAMNESIS OF ESOPHAGEAL DYSPHAGIA
● Start time: since when did it start and how did it start?
● Type of food that causes it: liquid, semi-liquid, semi-solid or solid
● Evolution: if it is episodic or permanent
● How can swallowing be made easier?
● Other accompanying or associated symptoms
● We are interested in knowing if this dysphagia is: DOMAIN TABLE
MECHANICAL (organic) FUNCTIONAL (motor)
➢ Short duration (months) ➢ Long duration (years)
➢ Gradual or abrupt beginning ➢ Gradual start
➢ Permanent (always, every time the patient ➢ Episodic (sometimes, often linked
eats) to emotional state)
➢ Logical sequence: first I get stuck with ➢ Paradoxical sequence: it is not
meat (solid) then ground meat (semi-solid), related to the consistency of the
puree (semi-liquid), water (liquid) and so on food
from solid to liquid ➢ Location: variable
➢ Location: fixed ➢ Swallowing maneuvers +
➢ Best example: ➢ Best example:
○ Esophageal cancer (tumor) ○ achalasia
○ cicatricial stenosis
3
