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The esophagus is a hollow tube beginning at the
very back of the pharynx (throat) and ending at the stomach. Its function is
to transport swallowed food and liquid from the throat, through the chest into
the stomach. It has little digestive function. In other words, it is not
active in the breakdown or absorption of food.
Esophageal Disorders
Reflux Esophagitis,
Hiatal Hernia, Heartburn These terms have all come to be associated
with the same condition. The valve located at the very bottom of the
esophagus just above the stomach is called the lower esophageal
sphincter . It generally remains closed unless a person swallows.
With swallowing, the valve opens, allowing liquids and food to pass into
the stomach, and then the valve closes again. In some patients, for
reasons we do not understand, the valve is incompetent and does not
close properly. When the valve is not closed, acid is allowed to reflux
(flow back up) from the stomach into the esophagus. This occurs more
often when a person is lying down because gravity does not keep the food
in his stomach as easily as when sitting or standing. It also occurs
after meals when the stomach is full, and this is a time when the
stomach makes large amounts of acid to begin the process of digestion.
Certain foods and other substances make this condition worse by further
interfering with the valve function. Included are alcohol,
peppermint, tobacco, caffeine and particularly fatty foods (fried
or greasy foods). These all lower the pressure of the valve making it
even more incompetent.
Heartburn A burning
or hot sensation underneath the breast bone. Some patients state that
they experience pain in the very pit of their stomachs while other
patients describe that the discomfort continues up under the breast bone
and sometimes into the throat. If the stomach contents reflux up into
the throat, a patient may complain of an increased flow of saliva, a
salty taste, or a sour or acid material in the back of his throat. Some
patients awaken choking at night. The esophagus is not designed to
tolerate this acid, and as a result the acid burns the lining of the
esophagus. Many Americans experience minor degrees of heartburn. However,
if it is a regular occurrence, the continual flow of acid up into the
esophagus can cause ulceration of the esophagus. This leads to scarring
at the bottom of the esophagus resulting in a stricture (narrowing).
A stricture may prevent the passage of solid food especially bread
or meat.
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