The oesophagus is a muscular tube about 25 cm long that carries food from the pharynx to the stomach. It starts at the lower border of the cricoid cartilage (C6), runs down through the neck and posterior mediastinum, and passes through the diaphragm at T10 to reach the stomach. Its upper third has skeletal muscle, its lower third smooth muscle and its middle third a mix of both.
| Location | From the pharynx at C6 through the neck and posterior mediastinum, behind the trachea and heart, to the stomach at about T11 |
|---|---|
| Parts |
|
| Nerve Supply | Recurrent laryngeal nerves (upper part); Vagus nerves via the oesophageal plexus (parasympathetic); Sympathetic trunks and greater splanchnic nerves |
| Blood Supply | Inferior thyroid artery (cervical part); Oesophageal branches of the thoracic aorta; Bronchial arteries; Left gastric artery (abdominal part); Left inferior phrenic artery |
| Venous drainage |
|
| Lymphatic drainage |
|
Moves swallowed food and fluid to the stomach by coordinated peristalsis and, with its sphincters, prevents air entering from above and stomach contents refluxing from below.
The oesophagus narrows at four points: the cricopharyngeus, where the aortic arch and the left main bronchus cross it, and the diaphragm; swallowed objects and tablets tend to lodge at these sites. In portal hypertension, veins at its lower end that connect the portal and systemic circulations dilate into varices that can bleed massively. Long-term acid reflux can turn its lower lining into columnar (Barrett) mucosa, the main precursor of oesophageal adenocarcinoma.
Dilated submucosal veins in the lower oesophagus caused by portal hypertension, which can rupture and cause life-threatening bleeding.
Replacement of the normal squamous lining of the lower oesophagus by columnar epithelium after chronic reflux, raising the risk of adenocarcinoma.
Loss of the nerve cells that relax the lower oesophagus, causing progressive dysphagia to solids and liquids, regurgitation and a dilated oesophagus.
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