Oesophageal Disease.
To understand how the oesophagus works – and how disease affects it – you have to understand the different cell types that line it. Let’s recap from our guide to the oesophagus – alternatively, you can read the full guide here.
Most of the oesophagus is lined with stratified squamous cells – these are thin cells that are arranged in layers a bit like scales. They regenerate at a high rate, making them great for withstanding mechanical injury from abrasive foods. Towards the lower end of the oesophagus you’ll find columnar cells – these are tall, rectangular cells that secrete mucus. They aren’t great at withstanding injury from abrasive foods and don’t regenerate as quickly, but they have high chemical resistance. A good job, considering their proximity to their stomach.
At the bottom of the oesophagus, separating it from the stomach, is the gastro-oesophageal junction (GOJ), which contains a sphincter that remains closed during rest. It opens to let food in, but remains closed most of the time to stop stomach acid from entering the oesophagus.
Because the oesophagus is primarily a transport organ, symptoms usually reflect obstruction, inflammation, or disordered movement. Acid reflux and other similar disorders are some of the most common, and you might be surprised to know that long-term reflux of stomach acid can actually impact your risk of developing oesophageal cancer.
Let’s have a look at oesophageal diseases in a bit more detail:
Types of oesophageal disease...
Reflux Disease
Gastro-oesophageal reflux disease (GORD) occurs when the LES fails to maintain adequate tone. Acid refluxes upward, irritating the squamous epithelium, which is not designed to tolerate acid exposure. Chronic inflammation, called oesophagitis, may develop. Patients experience heartburn, regurgitation, cough, or hoarseness. Repeated injury can lead to ulceration or narrowing (peptic strictures).
Barrett’s Oesophagus
(Barrett’s Metaplasia, Barrett’s Disease)
With long-term reflux, the body adapts. Squamous cells are replaced by columnar cells more resistant to acid. This metaplasia is protective in one sense but carries a risk of progression to adenocarcinoma. Surveillance endoscopy is often recommended.
Oesophageal Cancer
Two primary forms exist. Squamous cell carcinoma arises from the native squamous epithelium and is associated with smoking and alcohol. Adenocarcinoma arises from Barrett’s epithelium and is strongly linked to chronic reflux and obesity. Because early disease may be silent, progressive difficulty swallowing is often a late symptom.
Strictures
Achalasia
Achalasia is a motility disorder caused by degeneration of the myenteric plexus. The LES fails to relax, and coordinated peristalsis is lost. Food accumulates in the oesophagus, causing dysphagia for both solids and liquids, regurgitation, and chest discomfort. Treatment aims to reduce sphincter pressure.
Eosinophilic Oesophagitis
Eosinophilic oesophagitis is an immune-mediated inflammatory condition often associated with allergies. Eosinophils infiltrate the mucosa, leading to inflammation and fibrosis. Over time, the oesophagus may develop rings or strictures, and food impaction can occur.
Hiatal Hernia
When part of the stomach herniates upward through the diaphragmatic hiatus, the anti-reflux barrier weakens. Hiatal hernia often coexists with reflux disease.
How to take care of your oesophagus
If you want to be kind to your oesophagus, the big theme is simple: reduce irritation, reduce reflux, and avoid direct injury. Chronic acid exposure is one of its main enemies, so managing reflux matters. This can mean maintaining a healthy weight, avoiding heavy, late-night meals, limiting trigger foods (excess alcohol, caffeine, very fatty or acidic meals if they bother you), and not lying flat straight after eating. Smoking is another major irritant; it weakens the lower oesophageal sphincter and increases cancer risk, so stopping is one of the most protective things you can do. Repeated vomiting, untreated reflux, and long-term inflammation can all lead to scarring or cellular changes.
Direct injuries (such as swallowing caustic substances, taking pills without enough water, or very hot liquids) can also damage the lining. Eating mindfully, chewing well, staying hydrated, and seeking medical advice early if you develop persistent heartburn or difficulty swallowing all help protect this remarkably resilient but sensitive structure!
Useful Resources
If you want to know more about oesophageal health or oesophageal disease, here are some great resources to check out:
