There are various disorders of the esophagus, so we will discuss some of the most common here:

• Dysphagia, or trouble swallowing, is an esophageal disorder that may be caused by many different conditions. It can be due to esophageal narrowing such as strictures and scleroderma (which is fibrous replacement of tissues in the muscularis layer of the GI tract). Swallowing may also be difficult because of conditions that lead to lack of saliva such as Sjogrens (pronounced “showgrens”) syndrome, which is an immune system disorder characterized by dry eyes and mouth that often occurs with lupus or rheumatoid arthritis. Conditions that lead to weakness in the muscles that propel the bolus such as myasthenia gravis and multiple sclerosis can also lead to dysphagia. Lastly, dysphagia can be caused by conditions like achalasia where disruption of neural networks to the esophagus causes inability to relax the lower esophageal sphincter (LES).

• A diverticulum of the esophagus is an outpouching of the esophageal wall caused by weakness of the muscularis layer or motility issues. The most common manifestation is food getting stuck in the diverticulum which can lead to halitosis (bad breath). Complications such as esophagitis and ulceration may occur.

• Mallory-Weiss syndrome refers to a common esophageal laceration of non-penetrating mucosal tears at the gastroesophageal junction that can lead to bleeding in the GI tract. The longitudinal esophageal tears of this syndrome occur after severe retching or vomiting in conditions like chronic alcoholism, bulimia, sickness, or pregnancy. The bleeding usually stops on its own, but in severe cases a physician must do an esophagoscopy and stop the bleeding by cauterization or injection of vasoconstrictors like epinephrine or vasopressin at the site of injury.

• Hiatal hernias occur when a small portion of the stomach protrudes into the thoracic cavity through the esophageal hiatus, which is the opening in the diaphragm through which the esophagus and the vagus nerve pass. A hiatal hernia predisposes one to the development of gastroesophageal reflux disease (GERD) because it disrupts the “angle of His” between the esophagus and the stomach at the esophagogastric junction. This angle forms a valve that prevents reflux of gastric contents from entering the esophagus. There are two different types of hiatal hernias:

• A sliding hiatal hernia occurs when the lower part of the esophagus and some of the stomach protrudes into the diaphragm. This type is the most common of the two.
• A paraesophageal hiatal hernia (also called a rolling hernia) occurs when a separate portion of the stomach, usually the fundus, enters the thorax through a widened esophageal hiatus. The esophagus and the lower esophageal sphincter stay where they should. This type is especially dangerous because the stomach may be constricted so much that it loses blood supply.