This is the
very bottom of the esophagus, and compared to the photograph we saw in
gastroesophageal junction, this is very tightly shut; in fact, there is
only a pinhole opening. In patients with this condition, achalasia, there
is difficulty in swallowing food and it backs up into the esophagus. We
often have to operate on patients to open this area up, but there are
more recent therapies one of which is shown in the next photograph.