Functional anatomy of the gastroesophageal junction

The gastroesophageal junction is a complex anatomic and functional entity, a knowledge of which is essential for an understanding of the mechanisms of continence that prevent the reflux of gastric fluid toward the esophagus. This continence is subject to the control of two mechanisms: one intrinsic, related to the muscular fibers of the esophagus, which are under hormonal influence; and the other extrinsic, controlled by the muscle fibers of the diaphragm, whose function is linked closely to the movements of respiration . The mechanisms that preside over gastroesophageal continence are effectiv e only if the gastroesophageal junction oc cupies its normal position in it s muscular diaphragmatic channel. This anatomic concept, extended to includ e the functional data, should allow surgeons to have a more physiologic app roach to the surgical treatment of gash oesophageal reflux.