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Gastro-oesophageal reflux disease
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
GERD refers to the involuntary reflux of stomach contents into the oesophagus, causing irritation and damage. Whereas an adult may complain of heartburn, chest pain or burning, bloating, nausea and an acidic taste in the mouth, the presentation in children and infants is less likely to be so obvious. In most cases the reflux is minor and is an annoyance. It causes irritation in the child and may be responsible for unexplained bouts of vomiting. When reflux is suspected in a child, the important differentiation to be made is whether it is simple physiological reflux that is likely to self-resolve or whether complications of GERD are developing. Whereas the former can be managed by reassurance and conservative measures, the latter is likely to require treatment. Figure 3 may be useful in helping differentiate between mild and severe disease.
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Some understanding of the function of the abdominal organs is important. The oesophagus transmits food from the mouth to the stomach. It has no digestive function, although a number of medical conditions affect the oesophagus and make it difficult to swallow. The stomach acts as a reservoir; it produces dilute hydrochloric acid which initiates digestion. The liver is responsible for metabolizing digested food products. Bile, an emulsifying agent which aids digestion, is produced in the liver and concentrated in the gallbladder. When a particularly fatty meal is digested, the gallbladder contracts squeezing bile into the bile ducts and then into the duodenum, the first part of the small bowel. The food becomes emulsified with the bile and digestion is initiated. The pancreas produces enzymes that aid digestion. These enzymes are particularly caustic and if they escape from the pancreas can cause severe inflammation (pancreatitis). The pancreas also has one other function and that is sugar regulation; it produces insulin.
Saliva, Swallowing, and Lower Oesophageal Sphincter
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The oesophagus is a muscular tube that connects the pharynx to the stomach. The muscular coat of the upper third of the oesophagus, which consists of an outer longitudinal and an inner circular layer of striated muscle, contracts rapidly so that the bolus of food passes down the oesophagus. The muscles of the lower two-thirds of the oesophagus are smooth muscles with intrinsic peristaltic activity. The autonomic innervation of the oesophagus comprises extrinsic (vagus [parasympathetic] and sympathetic [via T8–L2 fibres]) and intrinsic enteric nervous systems. Between the muscularis mucosae and the circular muscle layer is the submucosal (Meissner's) plexus, which primarily controls secretion and blood flow. The myenteric (Auerbach) plexus lies between the circular and longitudinal muscles and primarily controls motility of the oesophagus. The mucous membrane of the oesophagus comprises stratified squamous epithelium, with mucous glands opening into the oesophageal lumen.
Current status and advances in esophageal drug delivery technology: influence of physiological, pathophysiological and pharmaceutical factors
Published in Drug Delivery, 2023
Ai Wei Lim, Nicholas J. Talley, Marjorie M. Walker, Gert Storm, Susan Hua
The esophagus is a part of the gastrointestinal tract (GI tract) that connects the pharynx to the stomach. It is a hollow, muscular channel that delivers swallowed food bolus to the stomach. The thickness of the esophageal wall in healthy individuals varies depending on the section of the esophagus, with the largest wall thickness during esophageal contraction of 4.70 mm (95%CI: 4.44-4.95) and during esophageal dilation of 2.11 mm (95%CI: 2.00-2.23) (Xia et al., 2009). The esophagus begins at the upper esophageal sphincter that is formed by the cricopharyngeal muscle and ends with the lower esophageal sphincter, which is surrounded by the crural diaphragm (Standring, 2020). While the average length of the esophagus in an adult is between 23 to 25 cm, the length in children at birth varies between 8 to 10 cm (Standring, 2020; Scott-Brown et al., 2008). The esophagus is lined with non-keratinized squamous epithelium in humans and the muscular elements are smooth muscle (Standring, 2020).
Tight junctions: from molecules to gastrointestinal diseases
Published in Tissue Barriers, 2023
Aekkacha Moonwiriyakit, Nutthapoom Pathomthongtaweechai, Peter R. Steinhagen, Papasara Chantawichitwong, Wilasinee Satianrapapong, Pawin Pongkorpsakol
Food travels through the esophagus from the pharynx to the stomach. The barrier functions of esophageal squamous stratified epithelium involve providing mucosal and submucosal defense against noxious intraluminal substances and regulating paracellular ion transport, which is mediated by claudins, the tetra-spanning transmembrane proteins of tight junctions, located at the apical and lateral membranes of esophageal epithelial cells.299–301 Claudins (CLDN)1, 4, and 7 are prominently expressed in the esophagus, which has basal pH of ~5–6.300,302 The esophagus is not normally exposed to a strongly acidic environment. Therefore, a decrease in esophageal pH leads to impaired esophageal barrier functions.303 The changes of claudin expression patterns and the acidic disruption of the esophagus are associated with several esophageal diseases.304
Dysphagia lusoria in a young woman with chest pain
Published in Baylor University Medical Center Proceedings, 2022
Busara Songtanin, Roy Jacob, Neha Mittal
Adachi and Williams classified patients based on types of variant aortic arches, noting that about 80% of aortic arches give rise to three vessels, which include the brachiocephalic trunk, left subclavian artery, and left common carotid artery. Most cases with aberrant vessels are asymptomatic.2,3 Symptom onset usually occurs in the fourth to fifth decades of life due to atherosclerotic changes, and a decrease in esophageal mobility with dysphagia is the most common symptom.3 Other symptoms include dyspnea, retrosternal pain, and chest pain due to arterial compression of the esophagus or trachea.4 Although this patient developed choking later in her clinical course secondary to compression of the proximal esophagus, she did not have a cough. Stenosis of arteria lusoria can also present with claudication, differences in the blood pressures in the arms, and Raynaud’s phenomenon of the right hand.5