Congenital Disorders Of The Esophagus

Esophagus (food pipe or gullet) is a tubular organ in the alimentary canal or Gastrointestinal tract through which food passes with the help of peristaltic movement of its muscle fibers. The tube’s upper end follows the foregut and it empties the food into the stomach.

The structure and functioning of the esophagus may be affected by various factors like gastric reflux, cancer, bleeding of blood vessels, mucosal tears, muscular constrictions and motility disorders acid damage to the stomach. These conditions may either be a birth defect (congenital) or acquired later with or without symptoms.

Congenital disorders

Certain esophageal abnormalities are present by birth such as atresia, fistulas, stenosis, webs, cysts, congenital muscular hypertrophy, lesions etc, frequency stated as 1 in 3000-5000 births.

Esophageal atresia is among the most common congenital diseases of the GI tract caused by abnormal development at the embryological stage, in which the esophagus ends in a blind-ended pouch instead of connecting to the stomach. In anatomical terms, a congenital obstruction of esophagus occurs which breaks the continuity of its wall. Symptom?

Esophageal webs are characterized by 2-3mm thin membranes of the esophageal tissue occurring along the esophagus partially obstructing it. The webs consist of mucosa and submucosa and are more common in the middle and inferior third of the tube. In most cases, webs are circumferential with either a central or an eccentric orifice. The main symptoms of webs are a thoracic pain, problems with swallowing food, nasopharyngeal reflux, aspiration, and in rare cases, perforation and food impaction.

The third disorder associated with the food pipe is Killian–Jamieson diverticulum in which an anterolateral outpouching, usually less than 1.5 cm occurs just below the upper esophageal sphincter. The disorder occurs as a result of congenital weakness in the area just below the cricopharyngeal muscle of the cervical region of the esophagus. It is more commonly seen in elderly patients and is generally asymptomatic.

In Schatzki ring disorder, the lower part of the esophagus narrows down causing difficulty in swallowing food, known as dysphasia. The narrowing is caused by a ring of mucosal tissue called the Schatzki ring lining the esophagus or muscular tissue.

Treatment in infants

The current method for repairing esophageal defects in infants is the minimally invasive technology of thoracoscopy. Medical advances in the methods of robotic-assisted surgery, esophageal replacement with tissue engineering, and in the utero intervention are expected to develop in the coming years. The success of such techniques also depends on the improvement in conditions like low birth weight, prenatal detection of the disorders and effective counseling.