{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:59:34Z","timestamp":1787846374405,"version":"build-2784847793"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2007,4,16]],"date-time":"2007-04-16T00:00:00Z","timestamp":1176681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Physiology"],"published-print":{"date-parts":[[2007,5]]},"abstract":"<jats:p>Quantifications of gastro\u2010oesophageal anatomy in cadavers have led some to identify the lower oesophageal sphincter (LOS) with the anatomical gastric sling\u2010clasp fibres at the oesophago\u2010cardiac junction (OCJ). However, <jats:italic>in vivo<\/jats:italic> studies have led others to argue for two overlapping components proximally displaced from the OCJ: an extrinsic crural sphincter of skeletal muscle and an intrinsic physiological sphincter of circular smooth\u2010muscle fibres within the abdominal oesophagus. Our aims were to separate and quantify <jats:italic>in vivo<\/jats:italic> the skeletal and smooth muscle sphincteric components pharmacologically and clarify the description of the LOS. In two protocols an endoluminal ultrasound\u2010manometry assembly was drawn through the human gastro\u2010oesophageal segment to correlate sphincteric pressure with the anatomic crus. In protocol I, fifteen normal subjects maintained the costal diaphragm at inferior\/superior positions by full inspiration\/expiration (FI\/FE) during pull\u2010throughs. These were repeated after administering atropine to suppress the cholinergic smooth\u2010muscle sphincter. The cholinergic component was reconstructed by subtracting the atropine\u2010resistant pressures from the full pressures, referenced to the anatomic crus. To evaluate the extent to which the cholinergic contribution approximated the full smooth\u2010muscle sphincter, in protocol II seven patients undergoing general anaesthesia for non\u2010oesophageal pathology were administered cisatracurium to paralyse the crus. The smooth\u2010muscle sphincter pressures were measured after lung inflation to approximate FI. The cholinergic smooth\u2010muscle pressure profile in protocol I (FI) matched closely the post\u2010cisatracurium smooth\u2010muscle pressure profile in protocol II, and the atropine\u2010resistant pressure profiles correlated spatially with the crural sling during diaphragmatic displacement. Thus, the atropine\u2010resistant and cholinergic pressure contributions in protocol I approximated the skeletal and smooth muscle sphincteric components. The smooth\u2010muscle pressures had well\u2010defined upper and lower peaks. The upper peak overlapped and displaced rigidly with the crural sling, while the distal peak separated from the crus\/upper\u2010peak by 1.1 cm between FI and FE. These results suggest the existence of separate upper and lower intrinsic smooth\u2010muscle components. The \u2018upper LOS\u2019 overlaps and displaces with the crural sling consistent with a physiological LOS. The distal smooth\u2010muscle pressure peak defines a \u2018lower LOS\u2019 that likely reflects the gastric sling\/clasp muscle fibres at the OCJ. The distinct physiology of these three components may underlie aspects of normal sphincteric function, and complexity of sphincter dysfunction.<\/jats:p>","DOI":"10.1113\/jphysiol.2006.124032","type":"journal-article","created":{"date-parts":[[2007,2,9]],"date-time":"2007-02-09T01:34:46Z","timestamp":1170984886000},"page":"961-975","source":"Crossref","is-referenced-by-count":73,"title":["Pharmacological dissection of the human gastro\u2010oesophageal segment into three sphincteric components"],"prefix":"10.1113","volume":"580","author":[{"given":"James G.","family":"Brasseur","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhys","family":"Ulerich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalipkumar K.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M. 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