Esophagus
General
Anatomy

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 4 January 2018, last major update August 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Esophagus[TI] anatomy[TI]

Cite this page: Weisenberg, E. Anatomy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusnormalanatomy.html. Accessed February 22nd, 2018.
Definition / general
  • Also called gullet
  • Muscular tubular structure 25 cm long in adults, 10 - 11 cm in newborns; develops from cranial portion of the foregut; connects pharynx and stomach; has cervical, thoracic and abdominal segments
  • Main purpose is to propel food from pharynx to stomach via peristalsis; secretes mucin for lubrication and to minimize reflux of gastric contents but has no other significant secretory or absorptive functions
  • Extends from cricopharyngeus muscle in pharynx (level of C6) to lower esophageal sphinchter at gastroesophageal junction (T11 / T12)
Regions (AJCC)
  • Cervical (lower border of cricoid cartilage to suprasternal notch / thoracic inlet, 5 cm long, begins 15 cm from incisors); contains striated muscle
  • Upper thoracic (suprasternal notch to tracheal bifurcation, 5 cm long, begins 20 cm from incisors); has striated and smooth muscle
  • Midthoracic (tracheal bifurcation to diaphragmatic hiatus, 5 cm long, begins 24 cm from incisors); has striated and smooth muscle
  • Lower thoracic and abdominal (10 cm long, begins 30 cm from incisors); extends past diaphragm to its junction with stomach; has smooth muscle only

  • Usual points of narrowing (possible sites of food / pill lodging): cricoid cartilage (due to cricopharyngeus muscle), aortic arch, anterior crossing of left main bronchus and left atrium, where it passes through diaphragm
  • Gastroesophageal junction: traditionally defined as macroscopic point of flaring of tubular esophagus or proximal limit of gastric rugal folds; endoscopic definition is Z ("zigzag") line at irregular boundary of squamous and columnar mucosa in distal esophagus, which is usually 2 - 3 cm proximal to macroscopic GE junction; histologic definition is proximal limit of gastric oxyntic (fundic) mucosa (Hum Pathol 2006;37:40)
  • Distal 1 - 2 cm of esophagus is often composed of cardiac or cardiac - oxyntic type of mucosa; there is no consensus if this is normal or due to reflux esophagitis
  • Esophageal sphincters: two areas of high pressure at rest (physiologic, not anatomic sphincters); upper esophageal sphincter is at cricopharyngeus and inferior pharyngeal constrictor muscles; lower esophageal sphincter is 2 - 4 cm proximal to esophagogastric junction at level of diaphragm (composed of intrinsic esophageal muscles, sling fibers of proximal stomach and crural diaphragm)
  • Vagotomy does NOT affect tone of lower esophageal sphincter; tone is affected by gastrin, acetylcholine and serotonin
Vessels and nerves
  • Arterial blood supply: cervical region - inferior thyroid artery; upper thoracic - bronchial and intercostal arteries; lower thoracic - aortic branches; abdominal - left gastric and inferior phrenic arteries; infarction is rare due to numerous anastomoses
  • Venous drainage: extensive submucosal venous plexus communicates with periesophageal veins; flows into inferior thyroid (upper 1/3), azygous (middle 1/3) and gastric veins (lower 1/3); azygous vein empties into superior vena cava and gastric veins into portal system; this connection between caval and portal venous systems explains esophageal varices due to portal hypertension
  • Nerves: left and right vagus nerves run lateral to esophagus, form plexi along anterior and posterior surfaces, then reunite to form anterior and posterior vagal trunks to stomach; have parasympathetic and sympathetic innervation
  • Lymphatic drainage: freely anastomosing networks in submucosa, muscularis propria and occasionally lamina propria; facilitate lengthwise tumor dissemination; upper third drains into paratracheal and internal jugular nodes, middle third to mediastinal nodes, lower third to nodes around aorta and celiac axis
  • Adjacent structures: cervical esophagus lies in posterior mediastinum, posterior to trachea and thyroid gland; is bounded by left and right recurrent laryngeal nerves and carotid sheaths; distal esophagus is posterior to left atrium and bounded by azygous veins; passes through opening in diaphragm called the hiatus
  • Incisura / angle of His: left side of esophagus forms sharp angle where it joins the stomach
Diagrams / tables

Images hosted on other servers:

Musculature

Gastroesophageal junction

Esophageal sphincter

Diaphragmatic crura

Arterial blood supply


Venous drainage

Nerves

Lymphatic drainage

Cervical region

Clinical images

Images hosted on PathOut server:

Z line - endoscopic appearance

Gross images

Images hosted on other servers:

Gastroesophageal junction

Microscopic (histologic) images

Images hosted on other servers:

Gastroesophageal junction

Gastric fundal mucosa