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Structure

Oesophagus

Not medically reviewed · Content last updated · 2 min read ·

This is the date the draft was written, not a medical review date.

The oesophagus is a muscular tube about 25 cm long that carries food from the pharynx to the stomach. It has cervical, thoracic and abdominal parts.

Terminologia Anatomica (Latin): Oesophagus · Open in the 3D atlas

Location

It begins at the lower border of the cricoid cartilage (about C6), descends behind the trachea through the superior and posterior mediastinum, passes through the diaphragm at the oesophageal hiatus (about T10), and joins the stomach at the cardia (about T11). The abdominal part is only 1 to 2.5 cm long.

Structure

The wall has mucosa (non-keratinised stratified squamous epithelium), submucosa, muscularis (striated in the upper third, mixed in the middle, smooth in the lower third) and an adventitia; there is no serosa in the thorax. Three constrictions are classically described: at the cricoid cartilage (pharyngo-oesophageal junction), where the aortic arch and left main bronchus cross it, and at the diaphragmatic hiatus.

Blood supply

The cervical part is supplied by the inferior thyroid arteries, the thoracic part by oesophageal branches of the aorta and bronchial arteries, and the abdominal part by the left gastric and inferior phrenic arteries. Venous drainage is to the inferior thyroid, azygos system and left gastric veins, forming a portosystemic anastomosis at the lower end.

Innervation

The oesophageal plexus is formed by the vagus nerves (with the recurrent laryngeal nerve for the upper part) and by sympathetic fibres from the thoracic sympathetic trunks. The striated upper part receives somatic motor fibres through the vagus (nucleus ambiguus), and peristalsis in the smooth part is coordinated by vagal and enteric neurones.

Function

The oesophagus transports the swallowed bolus to the stomach by primary and secondary peristalsis. The upper and lower oesophageal sphincters prevent entry of air and reflux of gastric contents.

Clinical correlations

Gastro-oesophageal reflux disease can lead to Barrett oesophagus and adenocarcinoma, whereas squamous cell carcinoma is typically in the upper and middle parts. Achalasia, strictures, perforation and foreign-body impaction (often at the constrictions) are other important problems, and oesophageal varices arise from portal hypertension through the portosystemic anastomosis.

Common exam points

  • About 25 cm long; begins at C6, pierces the diaphragm at T10, ends at the cardia about T11.
  • Three constrictions: cricoid cartilage, aortic arch and left main bronchus, diaphragmatic hiatus.
  • Muscle: striated in the upper third, smooth in the lower third, mixed between; no serosa in the thorax.
  • Lower end drains to azygos and left gastric veins (portosystemic anastomosis: oesophageal varices).
  • Squamous carcinoma (upper and middle parts) versus adenocarcinoma (lower part, Barrett).

References

  1. Drake RL, Vogl AW, Mitchell AWM. Gray's Anatomy for Students. Elsevier — Tier 3 (textbook)
  2. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Wolters Kluwer, 8th edition (2018) — Tier 3 (textbook)
  3. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Elsevier, 11th edition (2020) — Tier 3 (textbook)

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