Esophagus is part of the alimentary canal. It is a hollow muscle tube that is flattened in the anteroposterior direction, through which food from the pharynx enters the stomach.
The adult esophagus has a length of 25-30 cm. It is a continuation of the pharynx, begins in the neck area at the level of the VI-VII cervical vertebra, then passes through the chest cavity in the mediastinum and ends in the abdominal cavity at the level X-XI of the pectoral vertebrae, falling into the stomach. According to the areas of occurrence in the esophagus, the cervical, thoracic and abdominal parts are distinguished.
Esophageal lumen different, for its length it is customary to distinguish three narrowings. The first of them is located at the junction of the pharynx into the esophagus, the second – at the intersection of the esophagus with the left main bronchus, and the third – when passing through the diaphragm. In the upper part of the esophagus there is an upper esophageal sphincter, in the lower, respectively, the lower esophageal sphincter, which play the role of valves that ensure the passage of food through digestive tract only in one direction and preventing the ingress of aggressive contents of the stomach into the esophagus, pharynx, oral cavity.
Esophagus wall built from:
- mucous membrane;
- muscular and adventitial membranes.
The muscular membrane of the esophagus consists of two layers: the external longitudinal and internal circular. In the upper part of the esophagus, the muscular layer is formed by striated muscle fibers. At about one-third of the esophagus (counting from above), the striated muscle fibers are gradually replaced by smooth muscle. In the lower part of the muscle sheath consists only of smooth muscle tissue.
The mucous membrane is covered with stratified squamous epithelium, in its thickness there are mucous glands opening into the lumen of the organ.
Pain in the esophagus is perceived as a feeling of discomfort in the chest, may be accompanied by dysphagia and regurgitation.
Characteristic pain in the esophagus
In diseases of the esophagus, pain is usually localized behind the sternum, radiating to the back, to the right and left of the sternum, associated with food intake and is accompanied by a violation of swallowing. More often, pain is caused by damage to the esophagus:
- burns with concentrated solutions of caustic alkalis or strong acids;
- neuromuscular diseases (achalasia of the cardia, esophagospasm, diverticulum);
- inflammatory and peptic changes (esophagitis, peptic ulcer of the esophagus, hernia of the esophageal opening of the diaphragm, peptic strictures).
Causes of esophageal pain
Pain in the esophagus may be due to reflux esophagitis. This is an inflammatory process in the distal part of the esophagus, caused by the action on the mucous membrane of the organ of gastric juice, bile and intestinal contents during gastroesophageal reflux and accompanied by the appearance of characteristic symptoms (heartburn, retrosternal pain, dysphagia).
Pain in the esophagus is observed when it is damaged, which is divided into internal (closed) on the part of the mucous membrane and external (open), with penetrating injuries of the neck and chest.
It is also possible injuries of the esophagus from the inside if foreign bodies get into it. Pressure ulcers of the esophagus wall occur during prolonged presence of probes in it, from the pressure of the cuff of the intubation or tracheostomy tube.
Perforation of the esophageal wall can occur in various diseases:
- peptic ulcer;
- chemical burns.
When irradiated malignant tumors esophageal damage occurs due to decay tumors.
The first symptom of perforation of the esophagus is a sharp chest pain, tending to increase, aggravated by the following reflex actions of the body:
When spontaneous rupture of the esophagus unbearable pain occurs most often during vomiting, localized at the xiphoid process, radiating to the epigastric region, back, left shoulder. Subcutaneous emphysema occurs quickly (above the collarbone and on the neck), sometimes bloody vomiting.
Rupture of the esophagus
Stupid injuries neck, chest and abdomen can lead to malnutrition and necrosis esophageal walls as a result of squeezing it between the sternum and vertebral bodies. At the same time, damage to neighboring organs is often noted. Direct travama esophagus may occur during operations on the mediastinum and lung.
Experts also observe cases of spontaneous rupture of the esophagus. Factors predisposing to spontaneous ruptures of the esophagus are:
- alcohol intoxication;
- binge eating;
- vomiting during vomiting;
- tension of the abdominal muscles;
- contraction of the diaphragm and muscular layer of the stomach.
As a result of a significant increase in pressure in the esophagus, a longitudinal or transverse rupture of its wall occurs, more often directly above the diaphragm (posterior-neural in 95%, right in 5% of cases). A rupture of the esophagus occurs when trying to restrain vomiting or if there is a lack of coordination in the work of the above sphincters as a result of strong intoxication, diseases of the central nervous system.
The gap often has the appearance of a linear wound, can spread to the stomach. When spontaneous ruptures of the esophagus pain occurs suddenly (often during vomiting) in the xiphoid process, may radiate to the epigastric region, back, left shoulder. There is bloody vomiting, mediastinal and subcutaneous emphysema, shock develops, body temperature rises.
Foreign bodies in the esophagus
Most often, meat, fish and bird bones, pins, coins, buttons, needles, paper clips, less often pieces of wood, glass, dentures, nails, badges and other objects linger in the esophagus. Causes of foreign bodies entering the esophagus are different:
- negligence in the process of cooking, when foreign objects may fall into the food;
- hurried food, inattention while eating;
- insufficient chewing of food;
- the habit of workers in certain professions (shoemakers, tailors, carpenters) to keep needles and nails in the mouth while working;
- deliberate ingestion of foreign objects by mentally ill people.
When ingesting a foreign body in the esophagus, pain is localized behind the sternum, worse when swallowing, there is increased salivation. Further join dysphagia, fever, general condition worsens, peri-esophagitis symptoms appear, may develop later purulent mediastinitis. The delay of a foreign body in the esophagus threatens with complications even after a long period of time – from several months to several years.
Burns of the esophagus occur either by accidentally taking caustic substances or by suicidal attempt. More often there is a burn of the esophagus with concentrated solutions of alkalis and acids, less often with phenol, iodine, sublimate and other chemicals. Patients experience severe pain in the esophagus, in the epigastric region, in the mouth and pharynx.
With peptic esophagitis pain in the esophagus can occur during the ingestion of saliva, and during the passage of food through the esophagus. The pain is localized in the following parts of the body:
- behind the sternum or under the xiphoid process;
- radiates to the back in between the dislocation space, up the esophagus, neck, jaw, left half of the chest;
Often resembles coronary pain differing from it in the lack of connection with physical activity, often depending on the reception and nature of food, the patient’s body position, as well as the lack of effect on nitroglycerin.
Hernia of the esophageal opening
With hernia of the esophageal opening of the diaphragm, when particularly pronounced gastroesophageal reflux, pain in the esophagus can imitate angina pectoris. Patients are often without physical and nervous tension, often after a heavy meal, in the horizontal position there is pain behind the sternum, sometimes intense, often with typical irradiation to the left arm. With a large hernia, pain may radiate to the spine. The pain is not relieved by nitroglycerin, but becomes less intense in the upright position of the patient. Bouts of pain may be accompanied shortness of breath.
Neuromuscular diseases of the esophagus
Sometimes there is a spontaneous pain in the esophagus in the form of a pain crisis. With achalasia cardia pain crisis occurs in the early period of the disease, often at night, without an immediate cause. The pain is intense, radiating to the back, up the esophagus, neck, jaw, its duration from several minutes to several hours.
A crisis occurs 1-3 times a month. In some patients with achalasia of the cardia, pain is noted when trying to swallow food. In these cases, the passage of food through cardia leads to short-term, sometimes quite strong, usually cutting pain in the xiphoid process with the spread up the sternum, there is a feeling esophagus overflow, then the pain disappears and the patient continues to eat.
When cancer of the esophagus pain crisis occurs in advanced stages during germination tumors into the surrounding tissue. The pain is usually not associated with swallowing, is more pronounced at night, is localized behind the sternum or in the xiphoid process, may radiate in
Attacks of severe pain in the lower retrosternal region may be due to retrograde prolapse of the gastric mucosa into the esophagus. If this pain is not associated with food and is not accompanied by dysphagia, it is difficult to distinguish it from rest angina. Frequently recurring chest pain, resembling the pain of angina by localization and irradiation, can be caused esophagism (esophageal dyskinesia).
In many patients, it is possible to determine the relationship of pain with dysphagia. In some cases, esophagism occurs outside the meal, on the background of emotional or physical stress. It is difficult to distinguish esophageal dyskinesia from an attack of stenocardia, especially since taking nitroglycerin due to its relaxing effect on smooth muscles gives a positive effect in both cases.
With pains in the esophagus should immediately seek help from gastroenterologist. For injuries, you may need to consult a traumatologist and a surgeon. Pain in the esophagus can be accompanied by serious complications throughout the body, so you should responsibly treat the treatment of the disease.