ESOPHAGUS AND STOMACH

DR. ASMAA MOHAMMED MEKKEY

DEP. OF ANATOMY AND HISTOLOGY
REFERENCES :

1.BASIC HISTOLOGY ,12TH REVISED EDITION ,BY LUIZ JUNAQUEIRA ,ISBN :9780071630207

2. COLOR ATLAS OF HISTOLOGY 5TH EDITION,BY LESLIE P. GARTHNER AND JAMES L. HIATT, ISBN:0781788722

.3.TEXT BOOK OF HISTOLOGY 4TH EDITION LESLIE P. GARTNER, ISBN: 978-0-323-35563-6

:Learning Objectives

 Be able to describe the layers in the wall of the digestive

tract (mucosa, submucosa, muscularis externa and
adventitia/serosa), and explain how they differ in the
esophagus, and stomach.

 Know the histological differences in the upper, middle

and lower portions of the esophagus.

 Be able to recognize gastric glands, identify their

constituent cells, and know their secretory products.

 Be able to differentiate gastric glands, cardiac glands,

and pyloric glands.
ESOPHAGUS:

 The esophagus is subdivided into upper (entirely skeletal

muscle in the muscularis externa),middle (mixed smooth and
skeletal muscle) and lower (entirely smooth muscle) portions.
 The esophagus is a muscular tube, about 25-cm long in
adults, which transports swallowed material from the pharynx
to the stomach.
 The four layers of the GI tract first become well-established
and clearly seen in the esophagus. The esophageal mucosa
has nonkeratinized stratified squamous epithelium, and the
submucosa contains small mucus-secreting glands, the
esophageal glands, which lubricate and protect the mucosa.
Near the stomach the mucosa also contains groups of glands,
the esophageal cardiac glands, which secrete additional
mucus.
Esophageal Histology
Mucosa
The esophageal mucosa is composed of a stratified squamous
epithelium, fibroelastic lamina propria, and a smooth muscle layer
that is composed only of the longitudinally disposed muscularis
.mucosae
The mucosa of the esophagus is composed of three layers: epithelium,
.lamina propria, and muscularis mucosae
The lamina propria is typical. It houses esophageal cardiac
glands, which are located in two regions of the esophagus, one
cluster near the pharynx and the other near its juncture with the
stomach. It also houses occasional lymphoid nodules, members of
.the GALT (gut-associated lymphoid system)

The muscularis mucosae is unusual in that it consists only of a

single layer of longitudinally oriented smooth muscle fibers that
.become thicker in the vicinity of the stomach
The esophageal cardiac glands produce a mucous
secretion that coats the lining of the esophagus,
lubricating it to protect the epithelium as the bolus is
.passed into the stomach

Submucosa

The submucosa of the esophagus houses mucous

.glands known as the esophageal glands proper
The submucosa of the esophagus is composed of a
dense, fibroelastic connective tissue, which houses the
esophageal glands proper. The esophagus and the
duodenum are the only two regions of the alimentary
.canal with glands in the submucosa
Electron micrographs of these tubuloacinar glands indicate that their
secretory units are composed of two types of cells, mucous cells and
serous cells. Mucous cells have basally located, flattened nuclei and
.apical accumulations of mucinogen-filled secretory granules
,The second cell type, known as serous cells, possess round
.centrally placed nuclei
The secretory granules of these cells contain the proenzyme
pepsinogen and the antibacterial agent lysozyme. The ducts of these
.glands deliver their secretions into the lumen of the esophagus

Muscularis Externa and Adventitia

The muscularis externa of the esophagus is composed of both skeletal
.and smooth muscle cells
The muscularis externa of the esophagus is arranged in to two
layers, inner circular and outer longitudinal. However, these muscle
layers are unusual in that they are composed of both skeletal and
.smooth muscle fibers
The muscularis externa of the upper third of the esophagus
has mostly skeletal muscle and is served by the vagus nerve
(cranial nerve X), the middle third has both skeletal and
smooth muscle, and the lowest third has only smooth muscle
fibers and are served by nerve fibers of the enteric nervous
.system

Auerbach plexus occupies its usual position between the

inner circular and outer longitudinal smooth muscle layers of
.the muscularis externa

The esophagus is covered by an adventitia until it penetrates

.the diaphragm, after which it is covered by a serosa
 MEDICAL APPLICATION
The lubricating mucus produced in the esophagus offers
little protection against acid that may move there from
the stomach. Such movement can produce heartburn or
.reflux esophagitis

An incompetent inferior esophageal sphincter may result

in chronic heartburn, which can lead to erosion of the
esophageal mucosa or gastroesophageal reflux disease
.(GERD)

Untreated GERD can produce metaplastic changes in

the stratified squamous epithelium of the esophageal
.mucosa, a condition called Barrett esophaguS
STOMACH
The stomach is responsible for the formation and processing of the
.ingested food into an thick acidic fluid known as chyme

The stomach is a greatly dilated segment of the digestive tract whose main
:functions are
To continue the digestion of carbohydrates initiated by the amylase of ■
saliva
To add an acidic fluid to the ingested food and mixing its contents into a ■
.viscous mass called chyme by the mixing activity of the muscularis
To begin digestion of triglycerides by a secreted lipase, and ■
.To promote the initial digestion of proteins with the enzyme pepsin ■

Four major regions make up the stomach: the cardia, fundus, body, and
. pylorus
The cardia is a narrow transitional zone, 1.5-3 cm wide, between the
esophagus and the stomach; the pylorus is the funnel-shaped region that
.opens into the small intestine
Both these regions are primarily involved with mucus
.production and are similar histogically

The much larger fundus and body regions are identical

in microscopic structure and are the sites of gastric
.glands releasing acidic gastric juice

The mucosa and submucosa of the empty stomach have

large, longitudinally directed folds called rugae, which
.flatten when the stomach fills with food

The wall in all regions of the stomach is made up of all

.four major layers
Mucosa
Changing shortly at the esophagogastric junction ,the mucosal
surface of the stomach is a simple columnar epithelium that
.invaginates deeply into the lamina propria
The invaginations form millions of gastric pits, each with an opening
. to the stomach lumen
The surface mucous cells that line the lumen and gastric pits
secrete a thick, adherent, and highly viscous mucous layer that is
rich in bicarbonate ions and protects the mucosa from both rough
.effects of intraluminal food and the acidic effects of stomach acid
The gastric pits lead to long, branched, tubular glands that extend
.through the full thickness of the lamina propria

Stem cells for the epithelium that lines the glands, pits, and
stomach lumen are found in a narrow segment between each
.gastric pit and the gastric glands
 The stem cells divide asymmetrically, producing progenitor cells
. for all the other epithelial cells. Some of these move upward to
replace surface mucous cells, which have a turnover time of 4
.to 7 days

Other progenitor cells migrate more deeply and differentiate into

the secretory cells of the glands that turn over much more
.slowly than the surface mucous cells

The vascularized lamina propria that surrounds and supports

the gastric pits and glands contains smooth muscle fibers,
.lymphoid cells, capillaries, and lymphatics

Separating the mucosa from the underlying submucosa

.is a layer of smooth muscle, the muscularis mucosae
In the fundus and body the gastric glands themselves fill most of the
mucosa, with several such glands formed by branching at the neck of each
.gastric pit

Secretory epithelial cells of the gastric glands are distributed unequally and
.release products that are key to the stomach’s functions

These cells are of four major types and important properties of each are as
:follows
Mucous neck cells are present in clusters or as single cells among the ■
other cells in the necks of gastric glands and include many progenitor and
. immature surface mucous cells

Less columnar than the surface mucous cells lining the gastric pits, mucous
neck cells are often distorted by neighboring cells, but they have round
.nuclei and apical secretory granules
Their mucus secretion is less alkaline than that of the surface epithelial
..mucous cells
Parietal (oxyntic) cells produce hydrochloric acid (HCl) and are present ■
.among the mucous neck cells and throughout deeper parts of the gland
They are large cells, usually appearing rounded or pyramidal, each
with one (sometimes two) central round nucleus. The
cytoplasm is intensely eosinophilic due to the high density of mitochondria
.

An ultrastructural feature of an active parietal cell is a deep, circular

invagination of the apical plasma membrane to form an intracellular
.canaliculus with a large surface area produced by thousands of microvilli

carbonic anhydrase catalyzes the conversion of cytoplasmic water and

.+CO2 into HCO3 and H
The HCO3 + is transported from the basal side of the cell and H+ is
.−pumped from the cell apically, along with Cl

.In the lumen the H+ and Cl− ions combine to form HCl
While the gastric secretion becomes highly acidic, the mucosa itself
remains at a more neutral pH ,partly because of the bicarbonate
released into the lamina propria. The abundant mitochondria provide
.energy primarily for operating the cells’ ion pumps

Parietal cells also secrete intrinsic factor, a glycoprotein required for

.uptake of vitamin B12 in the small intestine

Parietal cell secretory activity is stimulated both by

parasympathetic innervation and by paracrine release of
histamine and the polypeptide gastrin from enteroendocrine
.cells
Chief (zymogenic) cells predominate in the lower ■
regions of the gastric glands and have all
.the characteristics of active protein-secreting cells

Ultrastructurally chief cells show abundant RER and numerous

. apical secretory granules

The granules contain inactive enzyme pepsinogens, precursors

which are converted in the acid environment of the stomach into
.active pepsins (Gr. peptein, to digest)

Pepsins are endoproteinases with broad specificity and maximal

activity at a pH between 1.8 and 3.5. Pepsins initiate the hydrolysis
.of ingested protein in the stomach

.Chief cells also produce gastric lipase, which digests many lipids
Enteroendocrine cells are scattered epithelial cells in ■
.the gastric mucosa with endocrine or paracrine functions

In the fundus small enteroendocrine cells secreting

serotonin (5-hydroxytryptamine) are found at the basal
. lamina of the gastric glands

In the pylorus other enteroendocrine cells are located in

contact with the glandular lumens, including G cells
.producing the peptide gastrin

Various enteroendocrine cells secreting different hormones,

usually peptides, are also found in the intestinal mucosa and
..are of major importance for function of the digestive tract
A low-magnification micrograph of
the stomach wall at the fundus shows
the relative thickness of the four
:major layers
the mucosa (M), the submucosa (SM),
the muscularis externa (ME), and the
serosa (S). Two rugae (folds) cut
transversely and consisting of
mucosa and submucosa are included.
The mucosa is packed with branched
tubular
glands penetrating the full thickness
of the lamina propria so that this
sublayer cannot be distinguished at
.this magnification
The muscularis mucosae (arrows),
immediately
beneath the basal ends of the gastric
glands, is shown. The submucosa is
largely loose connective tissue, with
blood vessels (V) and lymphatics.
.X12. H&E
Lamina Propria

The loose, highly vascularized connective tissue, the

,lamina propria, has a rich population of plasma cells
lymphocytes, mast cells, fibroblasts, and occasional
.smooth muscle cells

Much of the lamina propria is occupied by the approximately 15

million closely packed gastric glands, known as fundic (oxyntic)
. glands in the fundic region

Additionally, components of the GALT (gut associated lymphoid

.tissue) are also present
The pyloric region of the stomach has deep
gastric pits (P) leading to short, coiled pyloric
glands (G) in the lamina propria
Cardial glands are rather similar .)LP(
.histologically and functionally
Cells of these glands secrete mucus and
lysozyme primarily, with a few enteroendocrine
G cells also present. The glands and pits are
surrounded by cells of the lamina propria
connective tissue containing capillaries,
.lymphatics and MALT
Immediately beneath the glands is the smooth
muscle layer of the muscularis mucosae.
.X140. H&E
Muscularis Mucosae of the Stomach

The smooth muscle cells that compose the muscularis

.mucosae are arranged in three layers
The inner circular and outer longitudinal layers are well defined;
however, an occasional third layer, whose fibers are disposed
circularly (outermost circular), is not always evident

Differences in the Mucosa of the Cardiac and Pyloric Regions

The mucosa of the cardiac region of the stomach differs from that of
the pyloric region, in that the gastric pits are small, and the base of its
.glands is highly coiled

The cell population of these cardiac glands is composed mostly of

surface-lining cells, some mucous neck cells, a few DNES cells and
parietal cells, and no chief cells
.
The glands of the pyloric region contain the same cell types as
those in the cardiac region, but the predominant cell type in the
.pylorus is the mucous neck cell

In addition to producing soluble mucus, these cells secrete

.lysozyme, a bactericidal enzyme
. Pyloric glands are highly branchged tubular convoluted
Additionally, the gastric pits of the pyloric region are deeper than in
either the cardiac and fundus regions, extending approximately
.halfway down into the lamina propria

Submucosa of the Stomach

The dense, irregular collagenous connective tissue of the gastric
submucosa has a rich vascular and lymphatic network that supplies
.and drains the vessels of the lamina propria
The cell population of the submucosa resembles that of any
.connective tissue proper
Meissner submucosal plexus is in its accustomed location, within
. the submucosa
Muscularis Externa of the Stomach

The muscularis externa of the stomach is composed of

,three layers of smooth muscle: innermost oblique layer
.middle circular layer, and outer longitudinal layer

The smooth muscle cells of the gastric muscularis externa are

.arranged in three layers

The innermost oblique layer is not well defined, except in the

cardiac region. The middle circular layer is clearly evident along the
entire stomach and is especially pronounced in the pyloric region,
.where it forms the pyloric sphincter

The outer longitudinal muscle layer is most evident in the cardiac

region and the body of the stomach but is poorly developed in the
.pylorus
Auerbach myenteric plexus is located between the
middle circular and outer longitudinal layers of smooth
.muscle

The entire stomach is invested by a serosa composed

of a thin, loose, subserous connective tissue covered
.by a smooth, wet, simple squamous epithelium

This external covering provides an almost friction-free

environment during the mixing movements of the
.stomach