Normal and abnormal physiology, pharmacology, and anatomy of the gastroesophageal junction high-pressure zone

Ann N Y Acad Sci. 2016 Sep;1380(1):48-57. doi: 10.1111/nyas.13168. Epub 2016 Jul 28.


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.

Keywords: GERD; clasp muscle; gastroesophageal junction; lower esophageal sphincter; sling muscle.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Esophageal Sphincter, Upper / anatomy & histology
  • Esophageal Sphincter, Upper / drug effects
  • Esophageal Sphincter, Upper / physiology
  • Esophagogastric Junction / anatomy & histology*
  • Esophagogastric Junction / drug effects
  • Esophagogastric Junction / physiology*
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / physiopathology
  • Gastrointestinal Agents / pharmacology*
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Muscle, Smooth / drug effects
  • Muscle, Smooth / physiology*
  • Pressure


  • Gastrointestinal Agents