Skip to main content
SpringerLink
Log in

Does an anatomical sphincter exist in the distal esophagus?

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

The presence or absence of a lower esophageal sphincter (LES) has been a matter of debate. The aim of the present study was to revisit the gastro-esophageal region in an attempt to elucidate further the presence or absence of such a structure. The distal part of the esophagus was investigated in 12 fixed and 2 fresh cadavers with the aid of a dissecting microscope. Our findings demonstrated a clear thickening of the circular muscle layer of the gastro-esophageal region in all specimens. The mean length of this muscular thickening was measured to be 3.1 cm. The thickest part of this segment was at its midsection. This midpart had a mean thickness of 5.4 mm. The thickness of the esophagus immediately superior to the sphincter had a mean of 2.7 mm. We believe that the findings of the present study strongly suggest the presence of an internal esophageal sphincter in the distal esophagus. Physiologic experimentation would now be necessary to verify our morphological findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Boeckxstaens GE (2005) The lower esophageal sphincter. Neurogastroenterol Motil 17(Suppl 1):13–21

    Article  PubMed  Google Scholar 

  2. Bombeck CT, Dillard DH, Nyhus LM (1966) Muscular anatomy of the gastro-esophageal junction and the role of phrenoesophageal ligament. Ann Surg 164:643–652

    Article  PubMed  CAS  Google Scholar 

  3. Bremner CG, Shorter RG, Ellis FH (1970) Anatomy of feline esophageus with special reference to its muscular wall and phrenesophageal membrane. J Surg Res 10:327–331

    Article  PubMed  CAS  Google Scholar 

  4. Davidson G (2003) The role of lower esophageal sphincter function and dysmotility in gastroesophageal reflux in premature infants and in the first year of life. J Pediatr Gastroenterol Nutr 37:17–22

    Article  Google Scholar 

  5. Davis EDD (1953) The anatomy and physiology of the cardiac end of the oesophageus applied to hiatal hernia and achalasia. J Laryngol Otol 67:139–152

    Article  PubMed  CAS  Google Scholar 

  6. Delattre JF, Avisse C, Marcus C, Flament JB (2000) Functional anatomy of the gastroesophageal junction. Surg Clin North Am 80:241–260

    Article  PubMed  CAS  Google Scholar 

  7. Delattre JF, Palot JP, Ducasse A, Flament JB, Hureau J (1985) The crura of the diaphragm and the diaphragmatic passage. Applications to gastroesophageal reflux, its invention and treatment. Anat Clin 7:271–283

    Article  PubMed  CAS  Google Scholar 

  8. Dillard DH (1964) Esophageal sphincter and reflux. Surg Clin North Am 44:1201–1209

    Google Scholar 

  9. Fenoglio-Preiser CM, Noffsinger AE, Stemmermann GN et al (eds) (1999) The normal anatomy of the esophagus. In: Gastrointestinal pathology: an atlas and text, 2nd edn. Lippincott-Raven, Philadelphia, pp 15–29

  10. Gomes H, Lallemand A, Lallemand P (1993) Ultrasound of the gastresophageal junction. Pediatr Radiol 23:94–99

    Article  PubMed  CAS  Google Scholar 

  11. Gorenstein A, Cohen AJ, Cordova Z et al (2001) Hiatal hernia in pediatric gastresophageal reflux. J Pediatr Gastroenterol Nutr 33:554–557

    Article  PubMed  CAS  Google Scholar 

  12. Hayward J (1961) The lower end of oesophageus. Thorax 16:36–41

    Article  PubMed  CAS  Google Scholar 

  13. Hill LD, Tobias J, Morgan EH (1966) Newer concepts of the pathophysiology of hiatal hernia and esophagitis. Am J Surg 111:70–79

    Article  PubMed  CAS  Google Scholar 

  14. Hill LD, Aye RW, Ramel S (1990) Antireflux surgery: a surgeon’s look. Gastroenterol Clin North Am 19:745–775

    PubMed  CAS  Google Scholar 

  15. Holloway RH, Dent J (1990) Pathophysiology of gastresophageal reflux: lower esophageal dysfunction in gastresophageal reflux disease. Gastroenterol Clin North Am 19:517–535

    PubMed  CAS  Google Scholar 

  16. Kahrilas PJ, Lin S, Chen J, Manka M (1999) The effect of hiatus hernia on gastro-esophageal junction pressure. Gut 44:476–484

    Article  PubMed  CAS  Google Scholar 

  17. Kolesnikov LL (1990) Anatomo-topographic studies of the esophagogastric junction in humans. Arkh Anat Gistol Embriol 98:76–84

    PubMed  CAS  Google Scholar 

  18. Kramer P (1969) Does a sliding hiatus hernia constitute a distinct clinical entity? Gastroenterology 57:442–448

    PubMed  CAS  Google Scholar 

  19. Kuster GG, Innocenti FA (1997) Laparoscopic anatomy of the region of the esophageal hiatus. Surg Endosc 11:883–893

    Article  PubMed  CAS  Google Scholar 

  20. Liebermann-Meffert D (1993) Anatomical aspects in surgery of esophagus and cardia. Postgrad Gen Surg 5:122–130

    Google Scholar 

  21. Liebermann-Meffert D, Meffert LD, Allgöwer M, Schmid P, Blum AL (1979) Muscular equivalent of the lower esophageal sphincter. Gastroenterology 76:31–38

    PubMed  CAS  Google Scholar 

  22. Liebermann-Meffert D, Skandalakis JE (2004) Esophagus in Skandalakis’ surgical anatomy. The embryologic and anatomic basis of modern surgery. Paschalidis Medical, Athens, pp 108–111

    Google Scholar 

  23. Loukas M, Louis RG Jr, Childs RS (2006) Anatomical examination of the recurrent artery of Heubner. Clin Anat 19:25–31

    Article  PubMed  Google Scholar 

  24. Mittal RK (1990) Current concepts of the antireflux barrier. Gastroenterol Clin North Am 19:501–517

    PubMed  CAS  Google Scholar 

  25. Moore KL, Dalley AF (eds) (1999) Abdomen. In: Clinically oriented anatomy, 4th edn. Lippincott Williams & Wilkins, Baltimore, pp 221–226

  26. Moore KL, Agur AMR (eds) (2002) Abdomen. In: Essential clinical anatomy, 2nd edn. Lippincott Williams & Wilkins, Baltimore, p 145

  27. Moroz SP, Espinoza J, Cumming WA, Diamant NE (1976) Lower esophageal sphincter function in children with and without gastresophageal reflux. Gastroenterology 71:236–241

    PubMed  CAS  Google Scholar 

  28. Nagler R, Spiro HM (1961) Segmental response of the inferior esophageal sphincter to elevated intragastric pressure. Gastroenterology 40:405–407

    PubMed  CAS  Google Scholar 

  29. Ochoa JB, Rowe MI (1998) Gastresophageal reflux. In: O’Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (eds) Pediatric surgery, vol 1, 5th edn. Mosby-Year Book, St Louis, pp 1007–1028

    Google Scholar 

  30. Oglesby JE (1975) The E–G junction: two sphincters. Int Surg 60:135–139

    PubMed  CAS  Google Scholar 

  31. Orlando RC (1999) Reflux esophagitis. In: Yamada T, Alpers DH, Laine L, Owyang C, Powell DW (eds) Textbook of gastroenterology, vol 1, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 1235–1239

    Google Scholar 

  32. Orlando RC (2004) Diseases of esophagus. In: Goldman L, Ausiello D (eds) Cecil textbook of medicine, 22nd edn. Saunders, Philadelphia, pp 814–818

    Google Scholar 

  33. Peters JH, DeMeester TR (1999) Esophagus and diaphragmatic hernia. In: Schwartz SI, Shires GT, Spencer FC, Daly JM, Fischer JE, Galloway AC (eds) Principles of surgery, vol 1, 7th edn. McGraw Hill, New York, pp 1081–1106

    Google Scholar 

  34. Skandalakis JE, Ellis H (2000) Embryologic and anatomic basis of esophageal surgery. Surg Clin North Am 80:85–155

    Article  PubMed  CAS  Google Scholar 

  35. Skinner DB (1985) Hernias (Hiatal, Traumatic, and Congenital). In: Berk JE (ed) Bockus gastroenterology, vol 2, 4th edn. W.B. Saunders, Philadelphia, pp 705–747

    Google Scholar 

  36. Snell RS (2004) Clinical anatomy, 7th edn. Lippincott Williams & Wilkins, USA, p 233

    Google Scholar 

  37. Stein HJ, Liebermann-Meffert D, Demeester TP, Siewert JR (1995) Three-dimesional pressure image and muscular structure of the human lower esophageal sphincter. Surgery 117:692–698

    Article  PubMed  CAS  Google Scholar 

  38. Takano K, Iwafuchi M, Uchiyama M, Yagi M, Ueno A, Iwasaki M (1988) Evaluation of lower esophageal sphincter function in infants and children following esophageal surgery. J Pediatr Surg 23:410–414

    Article  PubMed  CAS  Google Scholar 

  39. Tottrup A, Forman A, Uldbjerg N et al (1990) Mechanical properties of isolated human esophageal smooth muscle. Am J Physiol 258:G338–G343

    PubMed  CAS  Google Scholar 

  40. Uz A, Elhan A, Ersoy M, Tekdemir I (2004) Internal anal sphincter: an anatomic study. Clin Anat 17:17–20

    Article  PubMed  CAS  Google Scholar 

  41. Williams PL, Bannister LH, Berry MM et al (eds) (1995) Alimentary system. In: Gray’s anatomy, 38th edn. Churchill Livingstone, Edinburgh, pp 1751–1753

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy, Ankara University Medical School, 06100, Sihhiye, Ankara, Turkey

    Nihal Apaydin, Aysun Uz & Alaittin Elhan

  2. Department of Anatomical Sciences, St George’s University, Grenada, West Indies

    Marios Loukas

  3. Department of Pediatric Neurosurgery, University of Birmingham Alabama, Birmingham, AL, USA

    R. Shane Tubbs

Authors
  1. Nihal Apaydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aysun Uz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alaittin Elhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marios Loukas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Shane Tubbs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nihal Apaydin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Apaydin, N., Uz, A., Elhan, A. et al. Does an anatomical sphincter exist in the distal esophagus?. Surg Radiol Anat 30, 11–16 (2008). https://doi.org/10.1007/s00276-007-0276-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-007-0276-3

Keywords

Search

Navigation