Parts

Parts

The Common Vein  Copyright 2008

The esophagus can be divided into 3 main sections:  the cervical, thoracic and abdominal portions.

The upper esophageal sphincter at the junction of the pharynx and the esophagus is called the cricopharyngeal muscle. The lower sphincter between the esophagus and the stomach is called the lower esophageal or cardiac sphincter.

 

Parts of the Esophagus
73368b07b esophagus normal motility contraction wave peristalsis primary stripping wave physiology function receptive relaxation upper esophageal sphincter lower esophageal sphincter LES UES esophageal body pharynx Davidoff Art Courtesy Ashley Davidoff MD

 

The cervical esophagus is the first part.  It starts around C5 (5th cervical vertebra), or approximately 15cm from the incisors. The trachea runs just anterior to the cervical esophagus.  Several nerve fibers, such as the recurrent laryngeal nerve course between these structures.  The thyroid can overlap the upper portion of the esophagus.

Upper Esophageal Sphincter

Upper Esophageal Sphincter

Cervical Esophagus

The barium swallow shows contrast moving from the back of the mouth into the pharynx into an open UES, as it enters the cervical esophagus (pink) at C5.  The trachea is overlaid in blue and lies anterior to the esophagus.

75010c03 esophagus pharynx cervical esophagus upper esophageal sphincter UES normal anatomy retropharyngeal air dx idiopathic perforation possibly due to straining carrying a heavy bag Barium Swallow Courtesy Ashley Davidoff MD

Upper Esophageal Spincter Open, (a) Closed (b) and beginning of Primary Stripping Wave

76204c esophagus cervical esophagus UES upper esophageal sphincter beginning of primary stripping wave normal physiology swallowing mechanism function single contrast barium swallow Courtesy Ashley Davidoff MD

Thoracic Esophagus

Thoracic Portion of the Esophagus

The thoracic esophagus in this double contrast barium swallow on the left and single contrast study on the right runs from T1 to about T5.  The esophagus is distended with air inthe double contrast study to optimise visualization of the mucosal surface, while the single contrast study enables evaluation of peristalsis.

49741 39562b01 esophagus GE junction gastroesophageal junction normal anatomy double contrast barium swallow upper GI Courtesy Ashley DAvidoff MD

The thoracic portion courses to approximately the 5th thoracic vertebrae. The thoracic portion can itself be subdivided into the upper, middle, and lower regions.

The upper region runs from the aortic arch superiorly while the middle region courses from the aortic arch to the inferior pulmonary vein.

Relations of the Upper Esophagus (yellow)
The CT scan of the upper chest shows the esophagus (yellow) at the thoracic inlet (a) leftward of the trachea (black) and medial to the left subclavian artery (a and b).  Lower down the trachea remains medial while the aortic arch becomes an anterior and lateral relation.(c)  Below the carina, (d) the left main stem bronchus is an anterior and leftward relation while the descending aorta lies lateral.

73610c02 esophagus relations left suckavian artery trachea aortic arch ;egt main stem bronchus normal thymus 30 year old normal anatomy CTscan Courtesy Ashley DAvidoff MD

 

Upper and Middle Portions of the Esophagus
The normal indentations on the esophagus include the aortic arch and knob seen in bright red in b.  The left bronchus is usually seen as a oblique line crossing the back of th esophagus, but in this case is seen as a focal indentation on the anterior wall.  The left atrium is seen pulsating against the distal esophagus (maroon) usually when the left atrium is enlarged.

76119c01 esophagus aorta left bronchus left atrium LA normal indentations on the esophagus relations barium swallow Courtesy Ashley Davidoff MD

 Finally, the abdominal portion runs from the inferior pulmonary vein to the LES or GE junction.

There is an overall slight S shape to the esophagus as it descends.  There is a convexity towards the left at the upper esophagus and a “right turn” at the lower esophagus around the 7th thoracic vertebrae.

GE Junction – The Z line
00633c01 esophagus stomach GE junction gastroesophageal junction mucosal folds rugae anatomy grosspathology normal Courtesy Ashley Davidoff MD

 

GE junction
00300 esophagus GE junction normal contrast barium X-Ray UGI upper GI imaging radiology
GE junction – Open
22221 esophagus stomach gastric gastroesophgeal junction GE junction longitudinal mucosal folds normal anatomy applied biology The Common Vein TCV double contrast upper GI barium swallow Davidoff MD
GE junction – a Crimped and Closed Junction
22222 esophagus stomach gastric gastroesophgeal junction GE junction longitudinal mucosal folds normal anatomy applied biology The Common Vein TCV double contrast upper GI barium swallow Davidoff MD

Normal Regular “Z” line

73474 squamocolumnar junction gastroesophageal junction squamous epithelium gastric epithelium columnar epithelium normal Z line anatomy histology endoscopy endoscope Courtesy Joshua Namias MD

 

Applied Biology

There are many conditions that can affect the subdivisions of the esophagus.  Neurologic conditions can alter the normal propagation and functioning of the esophagus.  Systemic conditions, such as Scleroderma or Systemic Lupus Erythemaosus, can also greatly affect proper esophageal function.  Whether the dysfunction is secondary to smooth or skeletal muscle involvement, or vascular or neurologic impairment, the physiologic sequela can be quite significant.

 

 

Webs in the Cervical Esophagus
01184c03 esophagus web Pattison Kelly Plummer Vinson squamous mucosa proliferation mechanical obstruction dysphagia barium swallow imaging radiology Courtesy Ashley Davidoff MD

 

 

The Normal (left) and Abnormal (right) Red and Swollen GE junction – Reflux Esophagitis

01239b01.800 esophagus stomach GE junction gastroesophageaal junction inflammed inflammation GERD red swollen reflux esophagitis grosspathology Courtesy Ashley Davidoff MD
Example of  Barrett’s Esophagus
73475 squamocolumnar junction gastroesophageal junction squamous epithelium gastric epithelium columnar epithelium Extension of columnar epithelium toward the squamous epithelium space occupation Barrett’s esophagus endoscopy endoscope Courtesy Joshua Namias MD

There is no capsule and the esophagus is attached to the other mediastinal structures by loose connective tissue.

 

Pedunculated Inflammatory Polyp
01191 esophagus pedunculated polyppolyp inflammatory polyp GE junction gastoesophageal junction barium swallow

At the GE junction the distal esophagus and GE junction is connected to the liver by the gastrohepatic ligament at the fissure for the ligamentum venosum., and attached to the diaphragm by the phrenicoesophageal ligament.  It is the latter ligament that gets stretched in theaging process resulting in loss of GE junction anchorage and the evolution of hiatal hernias inthe aging process.