Gastrooesophageal competence

The anti-reflux mechanism of the gastro-oesophageal junction separates the neutral pH of the oesophagus from the low pH of the stomach. The oesophageal mucosa is protected from the adverse effects of exposure to gastric secretion (acid, pepsin, trypsin), alkaline duodenal secretions and bile acids.

Contributory mechanisms to competence at the gastro-oesophageal junction include:

The physiological lower oesophageal sphincter, which demonstrates a mean resting end-expiratory pressure of 10-25 mm Hg and a mean resting mid-expiratory pressure of 15-35 mm Hg.

Oesophageal compression by muscle fibres of the right crus of the diaphragm as it passes through the oesophageal hiatus.

Valve-like effect of the acute angle of entry of the oesophagus into the stomach.

Mucosal folds at the gastro-oesophageal junction act as a valve.

The intra-abdominal portion of the oesophagus is subjected to intra-abdom-inal pressure that compresses the walls of the intra-abdominal segment of the oesophagus.

The hormone gastrin causes contraction of the muscle at the lower end of the oesophagus.

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