title: Longitudinal muscle of the esophagus: its role in esophageal health and disease.
abstract: OBJECTIVE
  The muscularis propria of the esophagus is organized into circular and longitudinal muscle layers. The function of the longitudinal muscle and its role in bolus propulsion are not clear. The goal of this review is to summarize what is known of the role of the longitudinal muscle in health, as well as in sensory and motor disorders of the esophagus.
  
  
  RESULTS
  Simultaneous manometry and ultrasound imaging reveal that, during peristalsis, the two muscle layers of the esophagus contract in perfect synchrony. On the contrary, during transient lower esophageal sphincter (LES) relaxation, longitudinal muscle contracts independent of the circular muscle. Recent studies have provided novel insights into the role of the longitudinal muscle in LES relaxation and descending relaxation of the esophagus. In certain diseases (e.g. some motility disorders of the esophagus), there is discoordination between the two muscle layers, which likely plays an important role in the genesis of dysphagia and delayed esophageal emptying. There is close temporal correlation between prolonged contractions of the longitudinal muscles of the esophagus and esophageal 'angina-like' pain. Novel techniques to record longitudinal muscle contraction are reviewed.
  
  
  CONCLUSIONS
  Longitudinal muscles of the esophagus play a key role in the physiology and pathophysiology of esophageal sensory and motor function. Neuro-pharmacologic controls of circular and longitudinal muscle are different, which provides an opportunity for the development of novel pharmacological therapies in the treatment of esophageal sensory and motor disorders.
authors.affiliation: Department of Medicine, Division of Gastroenterology, San Diego VA Healthcare System & University of California, San Diego, California 92161, USA. rmittal@ucsd.edu
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Mittal
mesh_terms: D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000502:physiology* / Q000503:physiopathology; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology; D009130:Muscle, Smooth / Q000000981:diagnostic imaging / Q000502:physiology* / Q000503:physiopathology; D010528:Peristalsis / Q000502:physiology; D014463:Ultrasonography