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Previous Volume 336:924-932 March 27, 1997 Number 13 Next

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The lower esophageal sphincter regulates the flow of food between the esophagus and the stomach. It is now clear that both the intrinsic smooth muscle of the distal esophagus and the skeletal muscle of the crural diaphragm constitute the sphincter mechanism at the lower end of the esophagus.¹ Furthermore, in normal subjects and patients with reflux esophagitis, transient relaxation of both sphincters rather than diminished lower esophageal sphincter pressure is the major mechanism of gastroesophageal reflux.² In this article we review the current understanding of the physiology of the sphincter mechanism at the esophagogastric junction and its relation to esophageal . . . [Full Text of this Article]

Historical Perspective

Anatomical Considerations

Esophagogastric-Junction Pressure under Various Physiologic Conditions

Neural Control of Contractility

Physiologic Importance of the Two Lower Esophageal Sphincters

Mechanisms of Gastroesophageal Reflux

Hiatal Hernia and Reflux Disease

Treatment of Reflux Disease

Achalasia of the Esophagus

Conclusions

Source Information

From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Box 10013, University of Virginia Health Sciences Center, Charlottesville, VA 22906-0013, where reprint requests should be addressed to Dr. Mittal.

References

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