The gastro-oesophageal junction is where the oesophagus joins the cardia of the stomach, just below the diaphragm and to the left of the midline at about T11. Inside, the pale squamous lining of the oesophagus meets the red columnar lining of the stomach at an irregular border called the Z-line. Several features here work together as an antireflux barrier.
| Location | Just below the oesophageal hiatus of the diaphragm, left of the midline at about T11, behind the left lobe of the liver |
|---|---|
| Parts |
|
| Nerve Supply | Anterior and posterior vagal trunks; Coeliac plexus (sympathetic) |
| Blood Supply | Oesophageal branches of the left gastric artery; Left inferior phrenic artery |
| Venous drainage |
|
| Lymphatic drainage |
|
Lets swallowed food into the stomach while preventing reflux of acid and stomach contents into the oesophagus.
The barrier depends on the lower oesophageal sphincter, the pinch of the right crus of the diaphragm, the acute angle of His and the phrenico-oesophageal ligament; weakening of these allows reflux and hiatus hernia. This junction is also where portal and systemic veins connect, so varices form here in portal hypertension. Cancers here are classified by their position relative to the junction because it affects surgical approach.
Upward movement of the junction and upper stomach through the oesophageal hiatus, weakening the antireflux barrier and promoting reflux.
Repeated reflux of stomach contents causing heartburn, regurgitation and oesophagitis, and over years Barrett change.
Longitudinal mucosal tear at the junction after forceful vomiting or retching, causing upper gastrointestinal bleeding that usually settles.
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