The esophagus (from the Greek oisophagos, which carries what we eat) is the part of the digestive tract which extends from the pharynx to the stomach and whose role is to ensure the descent of food.

The esophagus is an organ in the digestive tract that extends from the pharynx to the stomach through the diaphragm. It is a duct with a length of about 25 cm and 2 cm in diameter made up of three segments:

• The cervical esophagus: it follows directly from the pharynx. In front is the trachea, behind the spine and on the sides the thyroid gland and the large carotid and jugular vessels.
• The thoracic esophagus: it travels through the thorax and ends by crossing the diaphragm.
• The abdominal esophagus: it opens into the stomach.

At each end is a sphincter, the upper and lower esophageal sphincter. The latter controls the passage of the food bolus (porridge of crushed food surrounded by saliva) in the stomach and prevents reflux from the stomach. The wall of the esophagus is made up of four layers of tissue, or tunics: the mucosa, the submucosa, the muscularis, the serosa. This wall is endowed with peristalsis, that is to say that it is traversed by waves of contraction and relaxation which allow the descent of food. The functioning of the esophagus is controlled by a nervous system of its own located in its wall.

The esophagus, by means of peristaltic movements, allows food to flow into the stomach to begin digestion.

The food bolus passes into the esophagus at the time of swallowing thanks to the opening of its upper sphincter. Then it reaches the stomach through the opening of the lower sphincter.

Esophagitis : inflammation of the wall of the esophagus which may be due to an infection or an external burn (food, drinks that are too hot, etc.). Most often, this inflammation is a complication of chronic gastroesophageal reflux disease which causes acidic gastric juices to rise up against the lining of the esophagus. It causes erosions and ulcerations of the inner wall. In this case, it is called peptic esophagitis.

Hernie hiatale : rise of part of the stomach through the esophageal hiatus, small opening in the diaphragm which allows passage of the esophagus. There are two main types: sliding hernia (85 to 90% of cases) and rolling hernia. The hernia promotes gastroesophageal reflux disease.

Esophageal cancer : is a malignant tumor in the tissues of the wall of the esophagus. There are 2 main types: squamous cell carcinoma which involves cells lining the inner wall of the esophagus and adenocarcinoma which appears more often in the lower part of the esophagus. Chronic esophagitis is a well-known factor in esophageal cancer, although there are other risk factors.

Congenital anomalies

Atresia : congenital malformation of the esophagus. It is characterized by the absence of a segment of the esophagus which then opens into a cul-de-sac. Food and saliva therefore cannot get into the stomach. The cause of atresia is unknown, it is a problem with the development of the embryo. Atresia is most often associated with a tracheoesophageal fistula. These abnormalities require surgery.

Tracheoesophageal fistula : rare abnormality, it is an abnormal connection between the esophagus and the trachea. Food can then pass into the trachea and continue into the lungs, leading to serious breathing problems. It can be associated with atresia or occur in isolation, but this form represents only 4% of congenital anomalies of the esophagus5.

Motor disorders

Achalasia (or megaesophagus and cardiospasm) : motor disorder of the esophagus characterized by an absence of peristalsis and an absence of relaxation of the lower esophageal sphincter on swallowing. A rare disease of unknown cause, it prevents the progression of food. It is manifested by dysphagia (sensation of food blockage when swallowing or passing through the esophagus) and regurgitation.

Esophageal diverticula : abnormal pockets formed outside the esophagus that communicate with the cavity and in which food residues accumulate. There are different types: Zenker’s diverticulum (located at the pharyngeal-esophageal junction), mid-thoracic diverticulum (middle part of the esophagus) and epiphrenic diverticulum (last 10 centimeters of the esophagus, above the diaphragm). Motor disorders of the esophagus and gastroesophageal reflux are risk factors favoring their onset. They are manifested in particular by dysphagia, regurgitation and halitosis.

Smoking and obesity strongly contribute to the onset of gastroesophageal reflux disease. No convincing prevention exists, but certain measures can reduce burns. Watching your diet is a key point. Avoiding eating foods that are too fatty, for example, can help because fat slows down the evacuation of food from the stomach and reflux is more important when the stomach is full.

Le gastroesophageal reflux is also a risk factor for cancer, it is therefore necessary not to neglect it. Watching your weight and avoiding alcohol and tobacco consumption are also basic preventive measures against cancer.

20% of cases of esophageal ulcerations are due to taking certain medications (10). Too big or of a texture that makes swallowing difficult (eg capsules), these drugs adhere to the lining of the esophagus and release their more or less irritating active substances. In some cases, they can cause burns or even punctures. Doxycycline (an antibiotic), tetracyclines (antibiotics for the treatment of acne), or nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin) are examples of damaging drugs.

In general, certain precautions are recommended for taking the drugs: swallow the drug with sufficient water (200 mL), remain seated or standing for 5 to 10 minutes after taking and avoid the consumption of alcohol which dries up the skin. esophagus.

X-ray : medical imaging technique using X-rays. To explore the upper digestive tract (esophagus, stomach, duodenum), the examination is preceded by the ingestion of a so-called “contrast” liquid. It helps bring out the digestive tract when taking x-rays. This is then an esophagography.

Thoracic scanner : imaging technique which consists in “scanning” a given region of the body in order to create cross-sectional images, thanks to the use of an X-ray beam. The scanner is mainly indicated in the assessment of extension of the body. tumor in case of cancer (in and around the esophagus, mainly liver and lungs) and evaluation of a lesion outside the mucosa.

Endoscopy (or endoscopy and gastroscopy) : examination which allows to visualize the inside of the upper digestive tract (esophagus, stomach, duodenum) thanks to the introduction of a flexible tube called a fiberscope or endoscope. In the case of the esophagus, it can be practiced in particular to detect esophagitis, the presence of a foreign body or a diverticulum.

Ultrasound endoscopy : examination which combines endoscopy (visualization of the inside of the digestive tract) with ultrasound (ultrasound analysis of the wall and organs located beyond the wall). Ultrasound endoscopy is the most powerful examination for studying the lining of the esophagus, stomach or duodenum and neighboring organs. It is a little more efficient than the scanner in the assessment of the extension of the cancer.

Esophageal manometry : test that measures the contraction of the esophagus and the tone of the lower sphincter. It allows to highlight the existence of gastroesophageal reflux or motor disorders giving rise to abnormalities such as achalasia or diverticula.

esophageal pHmetry : measurement of the acidity (pH) of the esophagus. This test is used to diagnose and assess the extent of gastroesophageal reflux disease.

biopsy : examination which consists of taking a sample of the esophagus using a needle. The removed piece is subjected to microscopic examination and / or biochemical analysis to determine whether it is cancerous.

Oesophagectomie : partial or total surgical removal of the esophagus. It is the standard treatment for esophageal cancer. With partial removal, the remaining part of the esophagus is connected to the stomach. In the event of total ablation, the continuity of the digestive tract is most often restored by stretching the top of the stomach. This type of intervention causes feeding difficulties and / or malnutrition.