Gastro-esophageal junction
Citation, DOI, disclosures and article data
At the time the article was created Jeremy Jones had no recorded disclosures.
View Jeremy Jones's current disclosuresAt the time the article was last revised Bálint Botz had no recorded disclosures.
View Bálint Botz's current disclosures- Gastro-oesophogeal junction (GOJ)
- Gastro-oesophageal junction (GOJ)
- Gastro-oesophogeal junction
The gastro-esophageal junction (GEJ) (also known as the esophagogastric junction) is the part of the gastrointestinal tract where the esophagus and stomach are joined.
On this page:
Gross anatomy
The GEJ is normally mostly intra-abdominal and is 3-4 cm in length. To some extent, the esophagus slides in and out of the abdomen during respiration and when there is elevation of intra-abdominal pressure.
Histology
It is comprised of two histologically distinct areas:
- stratified squamous epithelium (same as the esophageal folds superiorly)
- columnar epithelium (same as the gastric rugae inferiorly)
Where these two distinct areas join, there is an abrupt but non-linear change in the mucosal layer: this is called the Z-line. The non-linear, zig zagging nature of the Z-line explains that the GEJ can be several centimeters in length, while the histological transition from esophageal folds to gastric rugae is abrupt.
Practical points
Unfortunately the GEJ is not directly visualized on plain film, which is of particular importance during the assessment of the position of nasogastric tubes. According to one study tube tips below the level of the disc between the 11th and 12th thoracic vertebra and/or more than 16 mm from the left side of the spine can be considered to be in the stomach 2. However for practical purposes the tube tip should ideally be at least 10 cm beyond from the expected location of the GEJ.
Quiz questions
References
- 1. Schumacher U. Thieme Atlas of Anatomy. Thieme Georg Verlag. (2006) ISBN:3131421118. Read it at Google Books - Find it at Amazon
- 2. Mervyn D. Cohen, Marsha L. Cirgin Ellett, Susan M. Perkins, Kathleen A. Lane. Accurate localization of the position of the tip of a naso/orogastric tube in children; where is the location of the gastro-esophageal junction?. (2011) Pediatric Radiology. 41 (10): 1266. doi:10.1007/s00247-011-2137-9
Incoming Links
- Esophageal and esophagogastric junction neuroendocrine tumor (staging)
- Epiphrenic diverticulum
- Hiatus hernia
- Paraoesophageal hernia
- A ring (oesophagus)
- Nasogastric tube positioning
- Siewert-Stein classification of oesophageal adenocarcinoma
- Stomach
- Lines and tubes: neonatal (chest radiograph)
- Esophagus
- Gastro-oesophageal reflux disease (summary)
- Esophageal balloon tamponade device
- Achalasia
- Gastric volvulus
- Dysphagia
- Medical abbreviations and acronyms (G)
- Lines and tubes (radiograph)
- Oesophageal carcinoma
- Esophageal and esophagogastric junction adenocarcinoma (staging)
- Esophageal and esophagogastric junction squamous cell carcinoma (staging)
Related articles: Anatomy: Abdominopelvic
- skeleton of the abdomen and pelvis
- muscles of the abdomen and pelvis
- spaces of the abdomen and pelvis
- anterior abdominal wall
- posterior abdominal wall
- abdominal cavity
- pelvic cavity
- perineum
- abdominal and pelvic viscera
- gastrointestinal tract
- spleen
- hepatobiliary system
-
endocrine system
-
adrenal gland
- adrenal vessels
- chromaffin cells
- variants
- pancreas
- organs of Zuckerkandl
-
adrenal gland
-
urinary system
-
kidney
- renal pelvis
- renal sinus
- avascular plane of Brodel
-
variants
- number
- fusion
- location
- shape
- ureter
- urinary bladder
- urethra
- embryology
-
kidney
- male reproductive system
-
female reproductive system
- vulva
- vagina
- uterus
- adnexa
- Fallopian tubes
- ovaries
- broad ligament (mnemonic)
- variant anatomy
- embryology
- blood supply of the abdomen and pelvis
- arteries
-
abdominal aorta
- inferior phrenic artery
- celiac artery
- superior mesenteric artery
- middle suprarenal artery
- renal artery (variant anatomy)
- gonadal artery (ovarian artery | testicular artery)
- inferior mesenteric artery
- lumbar arteries
- median sacral artery
-
common iliac artery
- external iliac artery
-
internal iliac artery (mnemonic)
- anterior division
- umbilical artery
- superior vesical artery
- obturator artery
- vaginal artery
- inferior vesical artery
- uterine artery
- middle rectal artery
-
internal pudendal artery
- inferior rectal artery
-
perineal artery
- posterior scrotal artery
- transverse perineal artery
- artery to the bulb
- deep artery of the penis/clitoris
- dorsal artery of the penis/clitoris
- inferior gluteal artery
- posterior division (mnemonic)
- variant anatomy
- anterior division
-
abdominal aorta
- portal venous system
- veins
- anastomoses
- arterioarterial anastomoses
- portal-systemic venous collateral pathways
- watershed areas
- arteries
- lymphatics
- innervation of the abdomen and pelvis
- thoracic splanchnic nerves
- lumbar plexus
-
sacral plexus
- lumbosacral trunk
- sciatic nerve
- superior gluteal nerve
- inferior gluteal nerve
- nerve to piriformis
- perforating cutaneous nerve
- posterior femoral cutaneous nerve
- parasympathetic pelvic splanchnic nerves
- pudendal nerve
- nerve to quadratus femoris and inferior gemellus muscles
- nerve to internal obturator and superior gemellus muscles
- autonomic ganglia and plexuses