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Overview of Esophageal and Swallowing Disorders

by Michael C. DiMarino, MD

The swallowing apparatus consists of the pharynx, upper esophageal (cricopharyngeal) sphincter, the body of the esophagus, and the lower esophageal sphincter (LES). The upper third of the esophagus and the structures proximal to it are composed of skeletal muscle; the distal esophagus and LES are composed of smooth muscle. These components work as an integrated system that transports material from the mouth to the stomach and prevents its reflux into the esophagus. Physical obstruction or disorders that interfere with motor function (motility disorders—see Esophageal Motility Disorders) can affect the system.

The patient’s history suggests the diagnosis almost 80% of the time. The only physical findings in esophageal disorders are cervical and supraclavicular lymphadenopathy caused by metastasis, swellings in the neck caused by large pharyngeal diverticula or thyromegaly, and prolonged swallowing time (the time from the act of swallowing to the sound of the bolus of fluid and air entering the stomach—normally 12 sec—heard by auscultation with the stethoscope over the epigastrium). Watching the patient swallow may help diagnose aspiration or nasal regurgitation. Most esophageal disorders require specific tests for diagnosis.

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