ESOPHAGUS

ESOPHAGUS
outline
Embryology
Congenital anomalies
Extent and structure
Clinical correlates
Course
Curvatures
Relations
Blood and nerve supply
Lymphatic drainage
Embryology
• The esophagus develops from the foregut immediately caudal to the
pharynx.
• During embryonic development, the esophagus and trachea initially share
a single-lumen tube at the anterior region of the foregut.
• As organogenesis proceeds, the anterior foregut separates and generates
the trachea ventrally and the esophagus dorsally. This tracheal-esophageal
separation occurs approximately 4-6 weeks of gestation in humans
• The foregut is divided into the esophagus dorsally and the trachea ventrally
by the tracheoesophageal folds, which fuse to form the tracheoesophageal
septum
• Initially, the esophagus is short, but it elongates rapidly, mainly
because of the growth and relocation of the heart and lungs
• The esophagus reaches its final relative length by the seventh week.
• Its epithelium and glands are derived from endoderm.
• The striated muscle forming the muscularis externa of the superior
third of the esophagus is derived from mesenchyme in the fourth and
sixth pharyngeal arches.
• The smooth muscle, mainly in the inferior third of the esophagus,
develops from the surrounding splanchnic mesenchyme
Congenital anomalies
Congenital anomalies of the esophagus are divided into three
categories:
1. Those involving the esophagus alone

2. Those in which the trachea is associated in the anomaly
3. Those in which anomalies of other structures influence the
anatomical configuration and thus the function of the esophagus.
Anomalies of the esophagus
alone
Absence
 Duplication
Atresia
Webs
 Stenosis -a. Fibrous strictures-b.
Failure of epithelialization
 Short esophagus
 Achalasia (cardiospasm) a. Simple
achalasia b. Extreme dilatation with
fibrous stricture at cardia
Combined esophago-tracheal anomalies
• 1. Tracheo-esophageal fistula with
esophageal atresia
• 2. Tracheo-esophageal fistula without
esophageal atresia
Esophageal anomalies due to congenital

anomalies of other structures
1. Obstructions due to cardiovascular
anomalies
2. Lung buds of esophageal origin
Extent
This muscular tube begins at the lower border of the cricoid cartilage (C6)
ends in the abdomen at the cardiac orifice, at T11.
passes through the diaphragm at T10 vertebra.
Length: 25 cm (10 inches). Width: 2 cm. Lumen:
It is flattened anteroposteriorly. Normally it is kept closed (collapsed) and opens

(dilates) only during the passage of the food.
Provides passage for chewed food.

The esophagus is divided into three
parts:
1. Cervical part (4 cm in length).
2. Thoracic part (20 cm in length).
3. Abdominal part (1–2 cm in length).

Structure
It is made up of 4 layers
1)Mucosa
epithelium- stratified squamous, non
keratinized epithelium,
 lamina propria –contains cardiac
esophageal glands
 muscularis mucosa - very thick , has
longitudinal smooth muscle .
2) Submucosa- mucous esophageal
glands.
3)Muscular layer- outer longitudinal and
inner circular
4)Fibrous membrane- dense connective
Structure
 The muscular layer comprises of both
smooth muscle and skeletal muscle and
distinction between them is difficult as
they overlap,
 upper third- skeletal muscle
 middle third- skeletal + smooth muscle
 lower third- smooth muscle
 Epithelium changes to columnar at the

squamocolumnar junction at the cardia
orifice.
 Sometimes distal part is lined by columnar

epithelium up to as much as proximal 3cm
beyond which is abnormal (barrets
esophagus)
Clinical correlate-
Esophageal cancer
• Can be squamous cell SC ( epithelial
cells) causes; tobacco, alcohol.
• Or adenocarcinoma AC (glandular
cells) causes; smoking, acid reflux,
obesity. 7-10> males.
• Barrets esophagus considered a

premalignant change for AC
course
The esophagus begins in the neck at the lower border of the cricoid
cartilage (at the lower border of C6 vertebra),
descends in front of the vertebral column passes through superior

and posterior mediastina,
pierces diaphragm (T10) and ends in the abdomen at the cardiac

orifice (T11) vertebra.
Esophageal curvatures
1.Two side-to-side curvatures, both
towards the left.
(a) At the root of the neck, before
entering the thoracic inlet.
(b) At T7 vertebra, before passing in

front of the descending thoracic aorta.
2. Two anteroposterior curvatures.

(b) corresponding to the curvature of
cervical spine.
(b) corresponding to the curvature of
thoracic spine.
Relations
Cervical part
Anteriorly, it is related to:
(a) trachea
(b) recurrent laryngeal nerve.

Posteriorly, it is related to:
(a) prevertebral fascia,
(b) longus colli muscles, and
(c) vertebral column.

Thoracic part
Anteriorly;
• Trachea
• Left principal bronchus
• Right pulmonary vein
• Left atrium in pericardium
• Posterior sloping fibres of diaphragm

Posteriorly
• Hemiazygos.(9-11 IC veins +
subcostal v)
• Acc. Hemiazygos veins. (5-8 IC

veins).
• Rt Posterior intercostal arteries.
• Thoracic duct.
• Vertebral column
Laterally thoracic part- rt
Right lung and pleura.
Azygos vein.
Right vagus nerve.
Thoracic duct- distal part

Lateral relations- left
• Arch of aorta.
• Left subclavian artery
• Thoracic duct- proximal part
• Left lung and pleura.
• Left recurrent laryngeal nerve.
• Descending thoracic aorta

Relations of abdominal esophagus
Anteriorly posteriorly
• Left gastric nerve • Right gastric nerve
• Posterior surface of left lobe of • Left crus of the diapragm
liver
Esophageal constrictions
• Cricopharyngeal sphincter- 15cm
from incisor teeth- narrowest
part, c6
• As its crossed by aorta- 22cm,T4
• By left principal bronchus-

27cm,T6
• As it passes Through diaphragm-

40cm,T10
Esophageal constrictions
Clinically important because;
• Site foreign bodies lodge
• Strictures develop most along the

sites.
• Predilection to carcinoma
• Difficult to pass Ng tube/

esophagoscope
Blood supply
• The cervical part- the inferior
thyroid arteries.
• Thoracic part- oesophageal

branches from the aorta and
bronchial arteries.
• Abd part - oesophageal branches

of; left gastric artery and left
inferior phrenic artery.
Venous drainage
• Cervical part -inferior thyroid veins-
brachiocephalic
• Thoracic part -azygos and

hemiazygos veins.
• Abdominal part is drained by

-hemiazygos vein, a tributary of
superior vena cava.
-left gastric vein, a tributary of portal
vein.
Note; abdominal part of esophagus is

the site of portocaval anastomosis.
Esophageal varices
• Abnormally dilated
submucosal veins in the
lower 1/3 of the
esophagus.
• Cause- portal hypertension; develops in 50% of people with liver cirrhosis.
• High tendency to rupture, 25-40% in pts with cirrhosis, with 30% mortality
risk/ episode of active variceal bleeding and 70% risk of reccurent
hemorrhage.
• Dx- typically endoscopy
• Tx- endoscopic ligation. Sclerotherapy, ballon tamponade. Tx of portal htn-

TIPS, liver transplant, distal splenorenal shunt
Lymphatic drainage
• Cervical part, the lymph is drained
into deep cervical lymph nodes.
• thoracic part, the lymph is

drained into posterior mediastinal
lymph nodes.
• From abdominal part, the lymph

is drained into left gastric lymph
nodes.
Nerve supply
• The esophagus is supplied by both parasympathetic
and sympathetic fibres.
• The parasympathetic fibres are derived from recurrent

laryngeal nerves(upper part) and esophageal plexuses
formed by vagus nerves(lower part).
• They provide sensory, motor, and secretomotor supply

to the esophagus.
• The sympathetic fibres are derived from middle

cervical ganglion (upper pt) and T5–T9 spinal(lower
part).

ESOPHAGUS

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ESOPHAGUS

1. Those involving the esophagus alone

Esophageal anomalies due to congenital

passes through the diaphragm at T10 vertebra.

Length: 25 cm (10 inches). Width: 2 cm. Lumen:

It is flattened anteroposteriorly. Normally it is kept closed (collapsed) and opens

Provides passage for chewed food.

1. Cervical part (4 cm in length).

2. Thoracic part (20 cm in length).

3. Abdominal part (1–2 cm in length).

 Epithelium changes to columnar at the

 Sometimes distal part is lined by columnar

• Barrets esophagus considered a

descends in front of the vertebral column passes through superior

pierces diaphragm (T10) and ends in the abdomen at the cardiac

(b) At T7 vertebra, before passing in

2. Two anteroposterior curvatures.

(b) recurrent laryngeal nerve.

(a) prevertebral fascia,

(b) longus colli muscles, and

(c) vertebral column.

• Left principal bronchus

• Right pulmonary vein

• Left atrium in pericardium

• Posterior sloping fibres of diaphragm

• Acc. Hemiazygos veins. (5-8 IC

• Rt Posterior intercostal arteries.

Right vagus nerve.

Thoracic duct- distal part

• Left subclavian artery

• Thoracic duct- proximal part

• Left lung and pleura.

• Left recurrent laryngeal nerve.

• Descending thoracic aorta

• As its crossed by aorta- 22cm,T4

• By left principal bronchus-

• As it passes Through diaphragm-

• Strictures develop most along the

• Difficult to pass Ng tube/

• Thoracic part- oesophageal

• Abd part - oesophageal branches

• Thoracic part -azygos and

• Abdominal part is drained by

Note; abdominal part of esophagus is

• Dx- typically endoscopy

• Tx- endoscopic ligation. Sclerotherapy, ballon tamponade. Tx of portal htn-

• thoracic part, the lymph is

• From abdominal part, the lymph

• The parasympathetic fibres are derived from recurrent

• They provide sensory, motor, and secretomotor supply

• The sympathetic fibres are derived from middle

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