confusion (hepatic ENCEPHALOPATHY) resulting from
toxins the damaged liver can no longer filter from
the blood.
ENDOSCOPY (in which the gastroenterologist
passes a lighted, flexible scope into the upper gas-
trointestinal tract) is the primary diagnostic proce-
dure, allowing the gastroenterologist to see the
ESOPHAGUS, STOMACH, and DUODENUM(first segment
of the SMALL INTESTINE). The endoscopy reveals the
swollen veins, which the gastroenterologist can
ligate (band or tie off) or inject with a DRUGto clot
the blood inside the VEIN. Bleeding esophageal
varices require emergency treatment, nearly
always endoscopic treatment to stop the bleeding.
A radiologist can do an interventional procedure
called TIPPS (transjugular intrahepatic portosys-
temic shunt) to decrease portal pressure and stop
variceal bleeding. When other efforts are not suc-
cessful a surgeon may place a shunt (tube that
reroutes the flow of blood) to improve blood flow
into the liver, relieving the pressure blood
encounters when trying to enter the liver. Usually
the end treatment for esophageal varices is LIVER
TRANSPLANTATION.
See also HYPOTENSION; LIVER FAILURE.
esophagitis INFLAMMATIONof the ESOPHAGUS. The
most common cause of esophagitis is irritation
from STOMACH contents that backflow into the
esophagus, such as occurs with GASTROESOPHAGEAL
REFLUX DISORDER (GERD) and ACHALASIA. INFECTION
resulting from HERPES SIMPLEX, CYTOMEGALOVIRUS
(CMV), or yeast (Candida) also can involve the
esophagus to cause esophagitis. Symptoms include
painful or difficult swallowing and DYSPEPSIA. The
diagnostic path may include ENDOSCOPYto exam-
ine, biopsy, or culture the esophagus. Treatment
targets the underlying cause and may include H 2
ANTAGONIST(BLOCKER) MEDICATIONSor PROTON PUMP
INHIBITOR MEDICATIONSto reduce the volume of gas-
tric acid. ANTIBIOTIC MEDICATIONSor ANTIFUNGAL MED-
ICATIONS are necessary to treat INFECTION. Most
people fully recover when the underlying condi-
tion resolves, though often esophagitis becomes
chronic.
See also BARRETT’S ESOPHAGUS; GASTRITIS; GAS-
TROENTERITIS; SWALLOWING DISORDERS.esophagus The muscular tube that extends from
the back of the THROATto the top of the STOMACH.
From 10 to 12 inches long, the esophagus carries
ingested food and fluids to the stomach to begin
the process of digestion. As the esophagus leaves
the throat its MUSCLEtissue is primarily striated
(voluntary); as the esophagus enters the stomach
its muscle tissue is smooth (involuntary). Though
a person can control the initiation of swallowing,
the processes that propel food down the esopha-
gus and into the stomach are involuntary.COMMON CONDITIONS AFFECTING THE ESOPHAGUS
ACHALASIA BARRETT’S ESOPHAGUS
DIVERTICULAR DISEASE DYSPEPSIA
ESOPHAGEAL ATRESIA ESOPHAGEAL CANCER
ESOPHAGEAL SPASM ESOPHAGEAL VARICES
ESOPHAGITIS GASTROESOPHAGEAL REFLUX DISORDER
(GERD)For further discussion of the esophagus within
the context of gastrointestinal structure and func-
tion, please see the overview section “The Gas-
trointestinal System.”
See alsoANUS;CECUM; COLON; DUODENUM; ILEUM;
JEJUNUM; RECTUM.42 The Gastrointestinal System