The esophagus is a hollow tube with muscles at each end, called sphincters. When the food is at the point of the actual swallow, the sphincter muscle at the top of the tube or esophagus opens to allow the food to pass. Once inside the esophagus, the muscles that make up the walls of the esophagus move in a wavelike motion called peristalsis which acts to push the food down the tube (that’s why you can eat while standing on your head- little known fact for the next time you are on Jeopardy!) Once the top sphincter (Upper Esophageal Sphincter) has activated, the functioning from there is generally out of the realm of the speech-language pathologist and becomes the concern of the gastroenterologist. However, what happens below this point may impact the whole swallowing process. For example, GERD (gastroesophageal reflux disease) happens with the bottom sphincter muscle (Lower Esophageal Sphincter) muscle is not remaining closed after food passes through from the esophagus into the stomach. Therefore, the food is being brought back into the esophagus and may ultimately go all the way back to the level of the throat and larynx where food may again be aspirated.