Skip to main content
Log in

An overview of the upper esophageal sphincter

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

The anatomy and physiology of the upper esophageal sphincter (UES) are complex. Much progress has been made over the past few years in our understanding this important sphincter. The closing muscles of the UES include the inferior pharyngeal sphincter, the cricopharyngeus (CP), and the cervical esophagus. The CP is composed of two parts, which may have different functions. The CP is innervated by the pharyngeal plexus and the recurrent laryngeal nerve. Tone of the UES is probably generated by numerous reflexes rather than by specific tone-generating circuitry. The major tonegenerating muscle is the CP, which is highly elastic and produces more active tension the more it is stretched. The UES opens by relaxation of the closing muscles, traction by muscles attached to the hyoid bone and thyroid cartilage, and pulsion of the bolus. The various muscles of the UES behave differently during its many dynamic states, so that similar functions are accomplished by different muscles.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Lang IM, Dantas RO, Cook IJ, et al.: Videoradiographic, manometric and electromyographic assessment of upper esophageal sphincter. Am J Physiol 1991, 260:G911-G919.

    PubMed  CAS  Google Scholar 

  2. Asoh R, Goyal RK: Manometry and electromyography of the upper esophageal sphincter in the opossum. Gastroenterology 1978, 74:514–520.

    PubMed  CAS  Google Scholar 

  3. Cook IJ, Dodds WJ, Dantas RO, et al.: Opening mechanisms of the upper esophageal sphincter. Am J Physiol 1989, 257:G748-G759.

    PubMed  CAS  Google Scholar 

  4. Gerhardt D, Hewett J, Moeschberger M, et al.: Human upper esophageal sphincter pressure profile. Am J Physiol 1980, 239:G49-G52.

    PubMed  CAS  Google Scholar 

  5. Kahrilas PJ, Dodds WJ, Dent J, et al.: Upper esophageal sphincter function during deglutition. Gastroenterology 1988, 95:52–62.

    PubMed  CAS  Google Scholar 

  6. Nilsson ME, Isberg A, Schiratzki H: The location of the upper oesophageal sphincter and its behavior during bolus propagation: a simulataneous cineradiography and manometric investigation. Clin Otolaryngol 1989, 14:61–65.

    PubMed  CAS  Google Scholar 

  7. Medda BK, Lang IM, Layman R, et al.: Characterization and quantification of a pharyngo-UES contractile reflex in cats. Am J Physiol 1993, 265:G963-G972.

    Google Scholar 

  8. Car A, Roman C: L'activite spontanee du sphincter oesophagien superieur chex le mouton. J Physiol (Paris) 1970, 62:505–511.

    CAS  Google Scholar 

  9. Lang IM, Sarna SK, Dodds WJ: The pharyngeal, esophageal, and gastrointestinal responses associated with vomiting. Am J Physiol 1993, 265:G963-G972.

    PubMed  CAS  Google Scholar 

  10. Elidan J, Gonen B, Shochina M, Gay I: Electromyography of the inferior constrictor and cricopharyngeal muslces during swallowing. Ann Otol Rhinol Laryngol 1990, 99:46–49.

    Google Scholar 

  11. Van Overbeek JJM, Wit HP, Paping RHL, et al.: Simultaneous manometry and electromyography in the pharyngoesophageal segment. Laryngoscope 1985, 95:582–584.

    Article  PubMed  Google Scholar 

  12. Jaradeh SS, Shaker R, Toohill RB: Electromyographic recording of the cricopharyngeus muscle in humans. Am J Med 2000, 108(Suppl 4a):40S-42S.

    Article  PubMed  Google Scholar 

  13. Jacob P, Kahrilas PJ, Herzon J, et al.: Determinants of upper esophageal sphincter pressure in dogs. Am J Physiol 1990, 259:G245-G251.

    PubMed  CAS  Google Scholar 

  14. Goyal RK, Martin SB, Shapiro J, et al.: The role of cricopharyngeus muscle in pharyngoesophageal disorders. Dysphagia, 1993, 8:253–258.

    Article  Google Scholar 

  15. Lang IM, Marvig J, Sarna SK: The contractile correlates of belching and their mechanisms of initiation [abstract]. Gastroenterology 1988, 95:876A.

    Google Scholar 

  16. Monges H, Salducci J, Naudy B: The upper esophageal sphincter during vomiting, eructation, and distension of the cardia: an electromyographic study in the unanesthetized dog. In Gastrointestinal Motility in Health and Disease. Edited by Duthie HL. Lancaster, England: MTP Press; 1978:575–583.

    Google Scholar 

  17. Lang IM, Marvig J, Sarna SK: Electromyography (EMG) of the pharyngoesophageal junction (PEJ) during various physiologic states [abstract]. Gastroenterology 1988, 94:249A.

    Google Scholar 

  18. Mu L, Sanders I: Neuromuscular organization of the human upper esophageal sphincter. Ann Otol Rhinol Laryngol 1998, 107:370–377. This study compared the neuromuscluar organization of the muscles of the UES and found significant differences and similarities among the inferior pharyngeal constrictor, the cricopharyngeus, and the cervical esophagus that may have physiologic and clinical significance.

    PubMed  CAS  Google Scholar 

  19. Brownlow H, Whitmore I, Willan P: A quantitative study of the histochemnical and morphometric characteristics of the human cricopharyngeus muscle. J Anat 1989, 166:67–75.

    PubMed  CAS  Google Scholar 

  20. Kristamundsdottir F, Mahon M, Froes MMQ, et al.: Histomorphometric and histological study of the human cricopharyngeus in health and in motor neuron disease. Neuropathol Appl Neurobiol 1990, 26:461–475.

    Google Scholar 

  21. Bonington A, Mahon M, Whitemore I: A histological and histochemical study of the cricopharyngeus muscle in man. J Anat 1988, 156:27–37.

    PubMed  CAS  Google Scholar 

  22. Bonington A: The histochemical characteristics of the human cricopharyngeus muscle. J Anat 1986, 146:251–257.

    Google Scholar 

  23. Medda BK, Lang IM, Dodds WJ, et al.: Correlation of electrical and contractile activities of the cricopharyngeus muscle in the cat. Am J Physiol 1997, 273:G470-G479. This is the only study to have investigated the physiologic characteristecs of the cricopharyngeus (CP) muscle. These authors found that the CP is highly elastic and behaves more like cardiac than striated muscle.

    PubMed  CAS  Google Scholar 

  24. Kobler JB, Datta S, Goyal RK, et al.: Innervation of the larynx, pharynx, amd upper esophageal sphincter of the rat. J Comp Neurol 1994, 349:129–147.

    Article  PubMed  CAS  Google Scholar 

  25. Sprague JM: The innervation of the pharynx in the rhesus monkey and the formation of the pharyngeal plexus in primates. Anat Rec 1944, 90:197–208.

    Article  Google Scholar 

  26. Lund WS, Adran GM: The motor nerve supply of the cricopharyngeal sphincter. Ann Otol Rhinol Laryngol 1964, 73:599–617.

    PubMed  CAS  Google Scholar 

  27. Hwang K, Grossman MI, Ivy AC: Nervous control of the cervical portion of the esophagus. Am J Physiol 1948, 154:343–357.

    CAS  PubMed  Google Scholar 

  28. Mu L, Sanders I. The innervation of the human upper esophageal sphincter. Dysphagia 1996, 11:234–238. See annotation below.

    Article  PubMed  CAS  Google Scholar 

  29. Brok HA, Copper MP, Stroeve RJ, et al.: Evidence of recurrent laryngeal nerve contribution in the motor innervation of the human cricipharyngeal muscle. Laryngoscope 1999, 109:7805–7808. Using anatomic and physiologic techniques, these two reported studies have provided new information indicating that the recurrent laryngeal nerve may supply motor innervation to the muscles of the UES, in particular to the cricopharyngeus.

    Article  Google Scholar 

  30. Hammond CS, Davenport PW, Hutchison A, et al.: Motor innervation of the cricopharyngeus muscle by the recurrent laryngeal nerve. J Appl Physiol 1997, 83:89–94.

    PubMed  CAS  Google Scholar 

  31. Lang IM, Medda BK, Shaker R: Functional studies of the innervation of the upper esophageal sphincter [abstract]. Gastroenterology 1998, 114:A783.

    Article  Google Scholar 

  32. Sanders I, Mu L: Anatomy of the human internal superior laryngeal nerve. Anat Rec 1998, 252:646–656.

    Article  PubMed  CAS  Google Scholar 

  33. Venker-van Haagen AJ, Hartman W, Wolvekamp WTC:Contributions of the glossopharyngeal nerve and the pharyngeal branch of the vagus nerve to the swallowing process. Am J Vet Res 1986, 47:1300–1307.

    PubMed  CAS  Google Scholar 

  34. Tadaki N, Hisa Y, Uno T, et al.: Neurotransmitters for the canine inferior pharyngeal constrictor muscle. Otolaryngol Head Neck Surg 1995, 113:755–759.

    Article  PubMed  CAS  Google Scholar 

  35. Temghi G, Polak JM, Rodrigo J, et al.: Calcitonin gene-related peptide-immunoreactive nerves in the tongue, epiglottis and pharynx of the rat: occurrence, distribution and origin. Brain Res 1986, 365:1–14.

    Article  Google Scholar 

  36. Rodrigo J, Polak JM, Fernandez L, et al.: Calcotinin generelated peptide immunoreactive sensory and motor nerves of the rat, cat, and monkey esophagus. Gastroenterology 1985, 88:444–451.

    PubMed  CAS  Google Scholar 

  37. Hudson LC: The origins of innervation of the canine caudal pharyngeal muscles: an HRP study. Brain Res 1986, 374:413–418.

    Article  PubMed  CAS  Google Scholar 

  38. Kitamura S, Ogata K, Nishiguchi T, et al.: Location of the motoneurons supplying the rabbit pharyngeal constrictor muscles and the peripheral course of their axons: a study using retrograde HRP or fluorescent labeling technique. Anat Rec 1991, 229:399–406.

    Article  PubMed  CAS  Google Scholar 

  39. Bieger D, Hopkins DA: Viscerotopic representation of the upper alimentary tract in the medulla oblongata in the rat: the nucleus ambiguus. J Comp Neurol 1987, 262:546–562.

    Article  PubMed  CAS  Google Scholar 

  40. Bao X, Wiedner EB, Altschuler SM: Transsynaptic localization of pharyngeal premotor neurons in rat. Brain Res 1995, 696:246–249.

    Article  PubMed  CAS  Google Scholar 

  41. Kahrilas PJ, Dodds WJ, Dent J, et al.: Effect of sleep, spontaneous gastroesophageal reflux, and a meal on upper esophageal sphincter pressure in normal human volunteers. Gastroenterology 1987, 92:466–471.

    PubMed  CAS  Google Scholar 

  42. Grelot L, Barillot JC, Bianchi AL: Pharyngeal motoneurons: respiratory-related activity and response to laryngeal afferents in the decerebrate cat. Exp Brain Res 1989, 78:336–344.

    PubMed  CAS  Google Scholar 

  43. Reynolds RPE, Effer GW, Bendeck MP: The upper esophageal sphincter in the cat: the role of cenral innervation assessed by transient vagal blockade. Can J Physiol Pharmacol 1987, 65:96–99.

    PubMed  CAS  Google Scholar 

  44. Lang IM, Medda BK, Shaker R: Sensory mechanisms of esophageal reflexes [abstract]. Gastroenterology 1999, 116:A804.

    Article  Google Scholar 

  45. Enzmann DR, Harell GS, Zboralske FF: Upper esophageal responses to intraluminal distension in man. Gastroenterology 1977, 72:1292–1298.

    PubMed  CAS  Google Scholar 

  46. Vakil NB, Kahrilas PJ, Dodds WJ, et al.: Absence of an upper esophageal sphincter response to acid reflux. Am J Gastroenterol 1989, 84:606–610.

    PubMed  CAS  Google Scholar 

  47. Gerhardt DC, Shuck TJ, Bordeaux RA, et al.: Human upper esophageal sphincter response to volume, osmotic and acid stimuli. Gastroenterol 1978, 75:268–274.

    CAS  Google Scholar 

  48. Wallin L, Boesby S, Madsen T: The effect of HCl infusion in the lower part of the esophagus on the pharyngoesophageal sphincter pressure in normal subjects. Scand J Gastroenterol 1978, 13:821–826.

    Article  PubMed  CAS  Google Scholar 

  49. Wilson JA, Pryde A, Macintyre CCA, et al.: Effect of esophageal acid exposure on upper esophageal sphincter pressure. J Gastrointest Motil 1990, 2:117–120.

    Article  Google Scholar 

  50. Kahrilas PJ, Dodds WJ, Dent J, et al.: Upper esophageal function during belching. Gastroenterology 1986, 91:133–140.

    PubMed  CAS  Google Scholar 

  51. Shaker R, Ren J, Xie P, et al.: Characterization of the pharyngo-UES contractile reflex in humans. Am J Physiol 1997, 273:G854-G858. This paper confirmed the existence of a new reflex of the UES in humans (previously found in an animal model [7]) that may have importance in the prevention of esophago-pharyngeal reflux.

    PubMed  CAS  Google Scholar 

  52. Kawasaki M, Ogura JH, Takenouchi S: Neurophysiologic observation of normal deglutition. I. Its relationship to the respiratory cycle. Larygoscope 1964, 74:1747–1765.

    CAS  Google Scholar 

  53. Lang IM, Medda BK, Shaker R: The mechanisms of ventilatory fuctuations in cricopharyngeus EMG [abstract]. Gastroenterology 2000, in press.

  54. Ertekin, C, Aydogdu I, Yuceyar N, et al.: Effects of bolus volume on oropharyngeal swallowing: an electrophysiologic study in man. Am J Gastroenterol 1997, 11:2049–2053. This study is the first to establish in humans that the timing of cricopharyngeus muscle activity during swallowing changes with the changes in volume and composition of the bolus. These results confirm the prior hypothesis that the swallowing program in humans is alterable.

    Google Scholar 

  55. Shaker R, Ren J, Kern M, et al.: Mechanisms of airway protection and upper esophageal sphincter opening during belching. Am J Physiol 1992, 262:G621-G628.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lang, I.M., Shaker, R. An overview of the upper esophageal sphincter. Curr Gastroenterol Rep 2, 185–190 (2000). https://doi.org/10.1007/s11894-000-0059-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-000-0059-z

Keywords

Navigation