The function of the oesophagus is simply to act as a channel for the end of the process of swallowing and the beginning of digestion in the stomach, and it participates in this process for only a few seconds. However, problems in the oesophagus can cause long-term misery and discomfort. The problems of the oesophagus are extrinsic and intrinsic to the oesophagus. The extrinsic problems such as GORD are the result of the acidic contents of the stomach coming into contact with the mucosa of the oesophagus, which if prolonged leads to complications such as inflammation and cytological changes. Oesophageal varices (see Chapter 7) also arise extrinsically as a result of increased pressure in the hepatic portal system, which is a consequence of liver failure. Intrinsic changes range from problems of motility to benign and malignant tumours. These conditions are especially distressing as they result in difficulty with swallowing, one of the most fundamental aspects of our existence associated with the ingestion of food. Malignancy of the oesophagus is especially worrying due to its poor prognosis.

The nurse has a range of responsibilities with regard to patients who have disorders of the oesophagus. These range from psychosocial support through the provision of simple and accurate explanations - augmenting those of the medical profession - to patients with any disorder of the oesophagus. However, the nurse can also be an invaluable source of advice on lifestyle changes that patients can make to alleviate mild symptoms. Oesophageal investigations involve endoscopy, often with the patient sedated but conscious, and the nurse has a crucial role in supporting such patients with the provision of information and accompanying the patient throughout the procedure. Nurses are also increasingly developing expertise as advanced and independent practitioners in this area of gastroenterology. Finally, in the case of life-threatening conditions such as oesophageal malignancy, the nurse's role extends beyond the usual support of the patient to those around the patient such as friends and family.

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