The esophagus is one of the upper parts of the digestive system. There are taste buds on its upper part. It begins at the back of the mouth, passing downwards through the rear part of the mediastinum, through the diaphragm, and into the stomach. In humans, the esophagus generally starts around the level of the sixth cervical vertebra behind the cricoid cartilage of the trachea, enters the diaphragm at about the level of the tenth thoracic vertebra, and ends at the cardia of the stomach, at the level of the eleventh thoracic vertebra. The esophagus is usually about 25 cm (10 in) in length.

Many blood vessels serve the esophagus, with blood supply varying along its course. The upper parts of the esophagus and the upper esophageal sphincter receive blood from the inferior thyroid artery, the parts of the esophagus in the thorax from the bronchial arteries and branches directly from the thoracic aorta, and the lower parts of the esophagus and the lower esophageal sphincter receive blood from the left gastric artery and the left inferior phrenic artery. The venous drainage also differs along the course of the esophagus. The upper and middle parts of the esophagus drain into the azygos and hemiazygos veins, and blood from the lower part drains into the left gastric vein. All these veins drain into the superior vena cava, with the exception of the left gastric vein, which is a branch of the portal vein. Lymphatically, the upper third of the esophagus drains into the deep cervical lymph nodes, the middle into the superior and posterior mediastinal lymph nodes, and the lower esophagus into the gastric and celiac lymph nodes. This is similar to the lymphatic drainage of the abdominal structures that arise from the foregut, which all drain into the celiac nodes.

The upper esophagus lies at the back of the mediastinum behind the trachea, adjoining along the tracheoesophageal stripe, and in front of the erector spinae muscles and the vertebral column. The lower esophagus lies behind the heart and curves in front of the thoracic aorta. From the bifurcation of the trachea downwards, the esophagus passes behind the right pulmonary artery, left main bronchus, and left atrium. At this point it passes through the diaphragm.

The thoracic duct, which drains the majority of the body's lymph, passes behind the esophagus, curving from lying behind the esophagus on the right in the lower part of the esophagus, to lying behind the esophagus on the left in the upper esophagus. The esophagus also lies in front of parts of the hemiazygos veins and the intercostal veins on the right side. The vagus nerve divides and covers the esophagus in a plexus.

The esophagus has four points of constriction. When a corrosive substance, or a solid object is swallowed, it is most likely to lodge and damage one of these four points. These constrictions arise from particular structures that compress the esophagus. These constrictions are

At the start of the esophagus, where the laryngopharynx joins the esophagus, behind the cricoid cartilage

Where it is crossed on the front by the aortic arch in the superior mediastinum

Where the esophagus is compressed by the left main bronchus in the posterior mediastinum

The esophageal hiatus where it passes through the diaphragm in the posterior mediastinum

The esophagus is surrounded at the top and bottom by two muscular rings, known respectively as the upper esophageal sphincter and the lower esophageal sphincter. These sphincters act to close the esophagus when food is not being swallowed. The upper esophageal sphincter is an anatomical sphincter, which is formed by lower portion of inferior pharyngeal constrictor, also known as cricopharyngeal sphincter due to its relation with cricoid cartilage of the larynx anteriorly. However, the lower esophageal sphincter is not an anatomical but rather a functional sphincter, meaning that it acts as a sphincter but does not have a distinct thickening like other sphincters.

The upper esophageal sphincter surrounds the upper part of the esophagus. It consists of skeletal muscle but is not under voluntary control. Opening of the upper esophageal sphincter is triggered by the swallowing reflex. The primary muscle of the upper esophageal sphincter is the cricopharyngeal part of the inferior pharyngeal constrictor.

Regards
Amalia Azzariti
Managing Editor
Journal of Clinical Oncology and Cancer Research