American Medical Association Family Medical Guide - American Medical Association [484]
Disorders of the Esophagus
The esophagus is the muscular tube, about 10 inches long, that runs from the back of your throat to your stomach. As you swallow food, the back of your tongue pushes it into the esophagus, the soft palate closes off the passage to the nose, and the flap of tissue (the epiglottis) at the top of the windpipe shuts to prevent food from entering the windpipe and lungs. Contractions of the esophageal muscles move the food down to the base of the esophagus. Muscles at the entrance to the stomach relax to let the food pass through. The lower esophageal sphincter muscle then tightens to prevent food, stomach acid, and digestive enzymes from going back up into the esophagus.
Pharyngeal Pouch
A pharyngeal pouch, also called an esophageal diverticulum, is a rare disorder in which a bulge or sac develops at the back of the throat (pharynx). It usually develops when the upper esophageal sphincter muscle fails to relax. The bundles of muscles spread apart and the muscle lining pushes through, creating an area where food settles during swallowing. As it fills with food, this area stretches and forms a baglike pouch. For unknown reasons, pharyngeal pouches occur most often in middle-aged men. In some cases, a person can inhale fluid and undigested food that has settled in the pouch (especially while sleeping), leading to pneumonia (see page 660).
Pharyngeal pouch
A pharyngeal pouch is an abnormal sac that bulges down from the back of the throat.
Symptoms
The symptoms of a pharyngeal pouch include difficulty swallowing and a feeling of swelling in the throat. A person may also cough and have bad breath and a metallic taste in the mouth from regurgitated liquid or undigested food. Some people lose weight because very little food gets into the stomach.
Diagnosis
Your doctor may be able to diagnose a pharyngeal pouch from your symptoms and a physical examination. He or she may recommend a barium X-ray (see page 767) of your throat and esophagus.
Treatment
Some people who have a pharyngeal pouch learn how to empty the pouch into their esophagus by manipulating it with their fingers, by getting into specific positions, or by coughing. If the pouch continues to expand or if you lose weight, your doctor may recommend surgery to remove the pouch.
Indigestion
Indigestion (often called heartburn) is a term used to describe discomfort in the upper abdomen. Some people get indigestion after consuming caffeine or high-fat or acidic foods. Drinking carbonated beverages or wine, beer, or liquor can cause indigestion in some people. Eating too fast or having an exceptionally large meal can also cause indigestion. Some people get indigestion when they are depressed, anxious, or nervous. Pregnant women, heavy smokers, and people who are overweight seem to be most susceptible.
Symptoms
Symptoms of indigestion include a dull, burning, gnawing, or sharp pain in the chest; an uncomfortable or bloated sensation in the abdomen; a sour taste in the mouth; belching; a sensation of butterflies in the stomach; and nausea. If you frequently or repeatedly get indigestion; if symptoms occur suddenly, seem more severe, or do not seem to have an apparent cause; or if you lose your appetite or lose weight for no obvious reason, see your doctor. The symptoms of indigestion can mimic a number of disorders, including a peptic ulcer (see page 755), stomach cancer (see page 757), angina (see page 19), or a heart attack (see page 567).
Swallowing
When you swallow, the muscles at the back of your throat push the partially digested food into the esophagus. A circular muscle at the top of the esophagus (the upper esophageal sphincter) relaxes, and the muscles of the throat grasp the bolus of food and push it into the esophagus. With powerful contractions called peristalsis, muscles in the esophagus propel the food down the rest of the esophagus toward your stomach.
Diagnosis
To make sure you don’t have anything