Esophageal Disease

ANATOMY OF THE ESOPHAGUS\

•  cricopharyngeus, the first region of anatomical constriction

Retropharyngeal danger space: possibility of infection spread ing retroesophageally into the thorax Tunica Muscularis Inner circular: continuous superiorly with the circumferential fibers of the inferior pharyngeal constrictor Outer longitudinal: upper third is striated (voluntary muscle) like the pharynx; middle third is a combination of striated and smooth muscle; lowest third is smooth muscle Innervation - - - - - - Figure The esophageal nerve plexus is composed of vagal afferent and efferent, sympathetic efferent, and segmental sensory components Parasympathetic preganglionic fibers Upper (cervical) portion from the recurrent laryngeal nerve Thoracic portion from the vagus via the pulmonary plexus (peribronchial) Ganglion cells located in myenteric plexuses Sympathetic postganglionic fibers Via nerves from cervical and thoracic chains From cervical ganglia and thoracic ganglia Sensory fibers (visceral afferent) Vagus: stretch, chemoreceptor, nociceptor; to vagal ganglia Segmental (parallel to sympathetics) with spinal nerves; to cervical and thoracic dorsal root ganglia   CLINICAL CORRELATES Zenker’s Diverticulum Top False (posterior) diverticulum Occurs between the cricopharyngeus and the rest of the inferior constrictor Caused by increased swallowing pressure Symptoms: upper esophageal dysphagia, halitosis, choking Treatment: cricopharyngeal myotomy, resected or suspended (without removal of diverticulum) via left cervical incision Clinical Correlates ↑ Traction Diverticulum True diverticulum, typically lateral Caused by granulomatous disease, chronic inflammation, or tumor Typically in mid-esophagus