Back To CoursePathophysiology Textbook
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Being burned by a loved one can make your heart ache. This type of heartburn is a little more emotional and less physical than the heartburn we'll be talking about in just a little bit.
In fact, in this lesson, we'll talk about some specific disorders, namely those related to the esophagus, which come about as a result of things moving about in the wrong directions.
I think that the unsung hero of the digestive system is the esophagus. Until there's something wrong with it, we don't really pay attention to it. The esophagus is the fleshy tube that connects your mouth to your stomach. If you had no esophagus, your food and water would just fill your chest up to the point that you wouldn't be able to breathe, so I think it's kind of important.
The esophagus moves food down into the stomach through a process of muscular contractions called peristalsis. Again, peristalsis is a sequence of smooth muscle contractions of the digestive system that helps to move food down the GI tract. Once the food moving down the esophagus nears the stomach, it reaches a point called the lower esophageal sphincter.
The muscles located here open up to allow food to pass into the stomach but quickly close down thereafter in order to prevent any stomach contents from going back up into the esophagus. Basically, the lower esophageal sphincter, or LES for short, acts like a clamp around the entrance to the stomach. It's like a gatekeeper to the cavernous underworld of your digestive system. That's how it's supposed to normally work, anyway.
Now, if something were to happen to the LES that would cause it to malfunction, you'd think that would be bad. And you'd be right. One end of the improper motility spectrum of the gastroesophageal junction, the place where the esophagus meets the stomach, is known as achalasia.
Achalasia is a failure of the smooth muscles of the LES to relax. Think about it for just a second. I just told you that the LES is like a clamp. If it's always clamped tight, as per achalasia, then food and water moving down the esophagus, ready to enter the stomach, would not be able to move through it. The LES basically screams: 'Thou shalt not pass,' to the food coming its way.
The reason this problem occurs is speculated to be because something destroys part of the parasympathetic innervation to the esophagus, thereby causing improper constriction of the LES. What I mean is, the parasympathetic nervous system, via the vagus nerve (also known as cranial nerve X), causes the relaxation of the LES. If parasympathetic control is compromised, the sphincter contracts very tightly instead. It's kind of like your nervous system basically short circuiting, throwing off a perfectly normal system in the process.
This is not good. Food begins to back up near the gastroesophageal junction, since it cannot pass into the stomach. Therefore, a person may regurgitate food contents or experience difficulty swallowing, also called dysphagia.
The backup of food causes the esophagus to dilate, or expand, as it's filled with food. This can be visualized with something called a barium swallow, where the patient drinks barium, a substance that appears very white on X-rays. The resulting appearance is called a 'bird's beak.'
While there's no cure for this condition, it can be managed through medication or surgery.
The exact opposite scenario of achalasia, where the LES is too relaxed, can cause something known as GERD, or gastroesophageal reflux disease. This is a condition where an abnormal amount of gastric juice moves from the stomach and up into the esophagus, resulting in esophagitis. Esophagitis is the technical term for the inflammation of the esophagus, in our case, caused by stomach acid. A very famous symptom of esophagitis is something anyone who chews an antacid, such as Tums, on a minute-by-minute basis is well aware of: heartburn.
Besides an improperly functioning LES, a motility disorder of the stomach such as delayed gastric emptying, aka gastroparesis, may cause back pressure upon the LES, resulting in reflux.
Just picture this: pick up a turkey baster and pretend the round balloon is your stomach and the esophagus is the tube running into it. Go to your sink and suck in as much water into the turkey baster and flip it upside down so the tip of it is pointing to the sky. If you squeeze on the bulb, you increase the pressure within in it, and the water will shoot right out. The same thing happens due increased pressure within the stomach during delayed gastric emptying.
Furthermore, something known as a hiatal hernia can distort the LES into a state of malfunction. A hiatal hernia is a condition where the gastroesophageal junction slides through and above the diaphragm, oftentimes due to increased pressure within a person's abdomen, due to things like heavy lifting, vomiting, and so on.
You should be able to imagine how we can diagnose a condition such as GERD. You should be aware that inflammation of something causes it to turn red, and if GERD can cause esophagitis, then we can visualize the redness of an acid-burned esophagus through an endoscopy, a procedure that uses a flexible scope, an endoscope, to visualize something inside of our body.
Once diagnosed, we can treat GERD by way of H-2 receptor antagonists, such as ranitidine, and proton-pump inhibitors, such as omeprazole, and surgery, if necessary.
So there you have it! Now you know why your uncle is constantly chewing on a bunch of Tums! You can make him feel better, or maybe not, by explaining to him all of the things we just learned a little bit ago.
Peristalsis is a sequence of smooth muscle contractions of the digestive system that helps to move food down the GI tract. Once the food moving down the esophagus nears the stomach, it reaches a point called the lower esophageal sphincter.
The LES can experience problems such as achalasia. Achalasia is a failure of the smooth muscles of the LES to relax. This can result in difficulty swallowing, or dysphagia.
Sometimes the LES relaxes too much instead and causes something known as GERD, or gastroesophageal reflux disease. This is a condition where an abnormal amount of gastric juice moves from the stomach and up into the esophagus, resulting in esophagitis. Esophagitis is the technical term for the inflammation of the esophagus, in our case, caused by stomach acid.
Among other things, GERD may be caused by a hiatal hernia, which is a condition where the gastroesophageal junction slides through and above the diaphragm, oftentimes due to increased pressure within a person's abdomen, due to things like heavy lifting, vomiting, and so on.
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Back To CoursePathophysiology Textbook
20 chapters | 274 lessons