Anatomy of the Reflux Barrier in Health, Disease, and Reconstruction

  • Andreas M. Schneider
  • Brian E. LouieEmail author


A thorough understanding of the anatomy and physiology of the components of the reflux barrier is essential to achieving success with any antireflux operation. The reflux barrier is a concept that has grown over the last century. Although there has always been an intuitive understanding of a valve-like mechanism between the esophagus and the stomach, the identification of the corresponding structures and understanding their individual role in creating a functional reflux barrier has been an ongoing effort.

As a functional unit, the reflux barrier is given the difficult task of maintaining aboral patency as well as offering a graded valve that selectively either allows for gastric venting or prevents retrograde reflux. It must perform this task between two visceral cavities with varying pressure and under constant motion. In health, a functional reflux barrier depends on the synergy of multiple components—an intact lower esophageal sphincter located within the abdominal pressure compartment, the crural diaphragm, the phrenoesophageal ligament and a functional flap valve mechanism with an intact angle of His. When one or more of these components fail, progressive pathological reflux can occur.

With this chapter, we identify the key components and contributors to the reflux barrier, describe their discovery as well as their function, and show the underlying principles that are employed during surgery to reestablish a functioning reflux barrier.


GERD Antireflux surgery Diaphragmatic hernia Lower esophageal sphincter Esophageal manometry 


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Thoracic SurgerySwedish Cancer Institute, Swedish Medical CenterSeattleUSA

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