Table of ContentsView AllTable of ContentsHow Does the Lower Esophageal Sphincter Work?What Does the Lower Esophageal Sphincter Do?Associated ConditionsTestsHow to Treat a Weak Lower Esophageal Sphincter
Table of ContentsView All
View All
Table of Contents
How Does the Lower Esophageal Sphincter Work?
What Does the Lower Esophageal Sphincter Do?
Associated Conditions
Tests
How to Treat a Weak Lower Esophageal Sphincter
The lower esophageal sphincter (LES) is a bundle of involuntary muscles—muscles that move or contract without you consciously controlling them. The LES sits right where the lower end of youresophagus—the tube that links your mouth and stomach—connects to the stomach.
The LES is sometimes called the gastroesophageal sphincter or gastroesophageal junction because of the two structures it connects. (“Gastro” means stomach.) It’s sometimes referred to as the cardiac sphincter as well because of its proximity to theheart.
Verywell / Michela Buttignol
This article discusses the anatomy and function of the lower esophageal sphincter, as well as the diagnosis and treatment of conditions associated with the LES.
Nerve stimulation for involuntary sphincters comes from autonomic nerves, which are part of theautonomic nervous system. It deals with automatic processes, including the function of glands and internal organs.
Structure
The esophagus (also called the gullet) is a tube of muscle that connects your mouth to your stomach. It’s about 8 and 10 inches long and has a sphincter at each end—theupper esophageal sphincterand the lower esophageal sphincter.
Asphincteris a ring of muscle that guards or closes the end of a tube. You have several of them in your digestive system and elsewhere throughout your body. They control the passage of liquids, solids, and gases.
The opening of a sphincter is called thelumen. When the sphincter contracts, the muscle shortens and the lumen closes. When the sphincter muscle relaxes, it lengthens and causes the lumen to open.
Your Digestive System and How It Works
Location
The esophagus starts at the bottom of thepharynx(throat). From there, it descends behind thetrachea(windpipe) and the heart. It then passes through thediaphragm, which is a membrane that sits just below the lungs.
Just below the diaphragm, at the bottom of the esophagus and top of the stomach, is where you’ll find the LES.
What Are the Other Digestive System Sphincters?Pyloric sphincter, which is at the lower end of the stomachIleocecal sphincter, which is between the small and large intestinesSphincter of Oddi, which controls secretions from the liver, pancreas, and gall bladder into theduodenum(the first part of the small intestine)Internal and externalanal sphincters, which control the passage of stools from your body
What Are the Other Digestive System Sphincters?
Pyloric sphincter, which is at the lower end of the stomachIleocecal sphincter, which is between the small and large intestinesSphincter of Oddi, which controls secretions from the liver, pancreas, and gall bladder into theduodenum(the first part of the small intestine)Internal and externalanal sphincters, which control the passage of stools from your body
The lower esophageal sphincter remains closed except for when you swallow. Then, it opens to allow food to move down into the stomach.
When you swallow, several structures react to block the airways, so food particles don’t get into your lungs. Food enters the throat, and then both esophageal sphincters open.
After your food goes through the upper esophageal sphincter, the muscles in the esophagus use a wavelike motion (called aperistaltic wave) to then push your food downward and through the LES to the stomach.
The LES stays open for about five seconds after you swallow. It then closes to keep food and digestive enzymes from washing back up into the esophagus.
How Your Brain Controls Swallowing
Medical conditions involving the LES include:
Acid Reflux, Heartburn, and GERD
When the LES doesn’t close tightly enough, stomach acid and food particles can rise back up into your esophagus. This is called acid reflux.
The main symptom of acid reflux isheartburn. The burning sensation is actually in your esophagus, but it’s felt in the general vicinity of the heart or in the throat.
If you have frequent heartburn, it’s important to treat it. Over time, the acid can cause damage to your esophagus.GERD is a severe form of acid reflux that can lead toserious complicationsif it’s not treated.
Symptoms of GERD typically include:
Treatments for acid reflux and GERD can include:
Surgery for GERD
Hiatal Hernia
Aherniais an abnormal protrusion. A hiatal hernia occurs when a part of the esophagus, stomach, or another structure protrudes through the opening where the esophagus passes through the diaphragm.
There are four types of hiatal hernia. Type I—the most common—involves the LES moving above the diaphragm instead of being below it, where it belongs. This is also called a sliding hiatal hernia. It can predispose you to GERD.
Type II involves herniation of the stomach. Type III involves the stomach and LES. Type IV involves another organ, such as thecolonorspleen.
Causes of hiatal hernia include:
Most hiatal hernias cause mild symptoms or no symptoms, so they don’t need to be treated or can be treated with lifestyle changes and over-the-counter antacids or antihistamines. However, if you develop GERD, your hernia does need to be treated.
In cases where the blood supply is cut off to the herniation, surgery is necessary. It involves pulling the herniated portion out of the diaphragm’s hole and closing it.
Hiatal Hernia Treatment Options
Achalasia
Symptoms of achalasia include:
Treatments for achalasia are aimed at creating an opening in the LES, such as:
So far, no treatments can restore muscle movement in the esophagus.
Muscle relaxants such as Nitrostat (nitroglycerin) or Procardia (nifedipine) may help as well. However, they can be inconvenient, cause unpleasant side effects, and tend to become less effective over time. They’re typically used only when other treatments fail or aren’t an option.
Hypertensive Lower Esophageal Sphincter
Hypertensive LES involves increased muscle contraction. The cause is often unknown, but it is sometimes related to GERD.
Symptoms of hypertensive LES often get worse slowly over time. They include:
Treatment is often myotomy—a minimally invasive surgery similar to that used for achalasia.
What is Nutcracker Esophagus?
Diagnostic tests performed for problems related to the lower esophageal sphincter include:
Barium Esophagram
An esophagram is a series ofX-raysof the esophagus. It can show problems with the LES, poor esophageal emptying, and the lack of a proper peristaltic wave.
Bariumis a white, chalky substance that you swallow to make some areas of your body show up better on an X-ray.
Barium esophagrams (also called barium swallow tests) are often used to diagnose:
When the stomach and first portion of the small intestine are included, it’s called an upper gastrointestinal (UGI) series.
Upper GI Endoscopy
In an upper GI endoscopy, oresophagogastroduodenoscopy(EGD), the esophagus, stomach, and duodenum are examined with a long, flexible tube called an endoscope. It’s inserted through the nose or mouth. It’s a common test when a doctor suspects a structural or inflammatory problem.
It’s used to diagnose:
While this test can’t diagnose achalasia, it’s usually performed when achalasia is suspected to rule out other possible causes of symptoms.
Esophageal pH Monitoring
This test is considered the gold standard for diagnosing GERD. It involves 24-hour monitoring of the acid levels in the lower esophagus, near the LES.
It involves placing a thin catheter that detects acid in the esophagus. The test reveals how many episodes of high acid you have and how long acid levels are elevated.
Does Anxiety Make GERD Worse?
Esophageal Manometry
Esophageal manometryinvolves a small tube with pressure sensors. It’s placed in the stomach via the nose or mouth and then slowly withdrawn.
The tube measures pressure at different points along the way. That includes the luminal (opening) pressure in both esophageal sphincters and throughout the esophagus.
This test is most often used when a doctor suspects:
Treatment of the LES will depend on the condition associated with it and may include:
Summary
The lower esophageal sphincter is a ring muscle at the point where the esophagus connects to the stomach. Its job is to stop stomach contents from leaking into the esophagus and mouth. If the lower esophageal sphincter doesn’t work properly, you can develop conditions like GERD, in which stomach acid moves back up and irritates the esophagus.
GERD and LPR: Similar, But Different Reflux Conditions
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD).MedlinePlus.Heartburn.University of California Los Angeles Health.Scleroderma.MedlinePlus.GERD.Merck Manual.Medicines for the treatment of gastric acidity.Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD) treatment.Johns Hopkins Medicine.Hiatal hernia.International Foundation for Functional Gastrointestinal Disorders.Disorders of the esophagus.International Foundation for Functional Gastrointestinal Disorders.Achalasia.Michigan Medicine.Pneumatic dilation.University of California San Francisco Department of Surgery.Heller myotomy.Memorial Hermann Foundation.Hypertensive lower esophageal sphincter.Johns Hopkins Medicine.Barium swallow.American Society for Gastrointestinal Endoscopy.Esophageal manometry & 24-hour pH and impedance tests.Additional ReadingVogt CD, Panoskaltsis-Mortari A.Tissue engineering of the gastroesophageal junction.J Tissue Eng Regen Med. 2020;14(6):855-868. doi:10.1002/term.3045
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD).MedlinePlus.Heartburn.University of California Los Angeles Health.Scleroderma.MedlinePlus.GERD.Merck Manual.Medicines for the treatment of gastric acidity.Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD) treatment.Johns Hopkins Medicine.Hiatal hernia.International Foundation for Functional Gastrointestinal Disorders.Disorders of the esophagus.International Foundation for Functional Gastrointestinal Disorders.Achalasia.Michigan Medicine.Pneumatic dilation.University of California San Francisco Department of Surgery.Heller myotomy.Memorial Hermann Foundation.Hypertensive lower esophageal sphincter.Johns Hopkins Medicine.Barium swallow.American Society for Gastrointestinal Endoscopy.Esophageal manometry & 24-hour pH and impedance tests.Additional ReadingVogt CD, Panoskaltsis-Mortari A.Tissue engineering of the gastroesophageal junction.J Tissue Eng Regen Med. 2020;14(6):855-868. doi:10.1002/term.3045
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD).MedlinePlus.Heartburn.University of California Los Angeles Health.Scleroderma.MedlinePlus.GERD.Merck Manual.Medicines for the treatment of gastric acidity.Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD) treatment.Johns Hopkins Medicine.Hiatal hernia.International Foundation for Functional Gastrointestinal Disorders.Disorders of the esophagus.International Foundation for Functional Gastrointestinal Disorders.Achalasia.Michigan Medicine.Pneumatic dilation.University of California San Francisco Department of Surgery.Heller myotomy.Memorial Hermann Foundation.Hypertensive lower esophageal sphincter.Johns Hopkins Medicine.Barium swallow.American Society for Gastrointestinal Endoscopy.Esophageal manometry & 24-hour pH and impedance tests.
Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD).
MedlinePlus.Heartburn.
University of California Los Angeles Health.Scleroderma.
MedlinePlus.GERD.
Merck Manual.Medicines for the treatment of gastric acidity.
Johns Hopkins Medicine.Gastroesophageal reflux disease (GERD) treatment.
Johns Hopkins Medicine.Hiatal hernia.
International Foundation for Functional Gastrointestinal Disorders.Disorders of the esophagus.
International Foundation for Functional Gastrointestinal Disorders.Achalasia.
Michigan Medicine.Pneumatic dilation.
University of California San Francisco Department of Surgery.Heller myotomy.
Memorial Hermann Foundation.Hypertensive lower esophageal sphincter.
Johns Hopkins Medicine.Barium swallow.
American Society for Gastrointestinal Endoscopy.Esophageal manometry & 24-hour pH and impedance tests.
Vogt CD, Panoskaltsis-Mortari A.Tissue engineering of the gastroesophageal junction.J Tissue Eng Regen Med. 2020;14(6):855-868. doi:10.1002/term.3045
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