title: Normal and abnormal physiology, pharmacology, and anatomy of the gastroesophageal junction high-pressure zone.
abstract: The high-pressure zone of the gastroesophageal junction acts as a multifunctional valve that comprises different groups of smooth muscles located in the distal esophagus and the proximal stomach, in addition to the extrinsic crural diaphragm, composed of skeletal muscle. In this review article, we evaluate the current literature with respect to human subjects, discussing the anatomic locations and physiologic and pharmacologic processes controlling these muscles. These muscles work individually and as a group to prevent reflux of gastric contents while allowing anterograde passage of food and liquid and retrograde passage of gas. We also reviewed new findings with respect to abnormalities that are permissive of reflux of gastric contents into the esophagus, which may lead to gastroesophageal reflux disease.
authors.affiliation: Department of Medicine (Gastroenterology), The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York. lmiller7@nshs.edu.
authors.forename: Larry
authors.initials: L
authors.lastname: Miller
authors.affiliation: Department of Medicine (Gastroenterology), The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York.
authors.forename: Anil
authors.initials: A
authors.lastname: Vegesna
authors.affiliation: Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Ruggieri
authors.affiliation: Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Alan
authors.initials: A
authors.lastname: Braverman
mesh_terms: D049631:Esophageal Sphincter, Upper / Q000033:anatomy & histology / Q000187:drug effects / Q000502:physiology; D004943:Esophagogastric Junction / Q000033:anatomy & histology* / Q000187:drug effects / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D009130:Muscle, Smooth / Q000187:drug effects / Q000502:physiology*; D011312:Pressure
chemical_list: D005765:Gastrointestinal Agents
keywords: GERD; clasp muscle; gastroesophageal junction; lower esophageal sphincter; sling muscle