The hypertensive lower esophageal sphincter

• Published in: The American journal of surgery 1996-11, Vol.172 (5), p.439-443
• Main Authors: Katada, Natsuya, Hinder, Ronald A., Hinder, Paul R., Lund, Richard J., Perdikis, Galen, Stalzer, Rebecca A., McGinn, Thomas R.
• Format: Article
• Language: English
• Subjects: Achalasia; Adolescent; Adult; Aged; Aged, 80 and over; Esophageal Motility Disorders - etiology; Esophageal Motility Disorders - physiopathology; Esophageal Motility Disorders - surgery; Esophageal sphincter; Esophagogastric Junction - physiopathology; Esophagus; Female; Follow-Up Studies; Gastroesophageal reflux; Humans; Hypertension; Hypertension - complications; Hypertension - physiopathology; Male; Manometry; Middle Aged; Patients; Sphincter
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(96)00219-X

This study defines the entity of the hypertensive lower esophageal sphincter (HLES) and its treatment, including surgical implications. Esophageal manometry was performed on 1,300 patients. Of these, 53 (4%) had HLES with resting pressure >26.5 mm Hg, defined as the upper limit of normal resting LES pressure. Thirty-two of these patients had 24-hour esophageal pH studies. The response to treatment was assessed. Fourteen patients (26%) with HLES had achalasia. Of the remaining 39 (74%), 25 had an isolated HLES with normal esophageal body motility, 5 had a nonspecific esophageal motiliry disorders (NEMD), 4 were post-Nissen fundoplication, 3 had a nutcracker esophagus, and 2 had diffuse esophageal spasm (DES). Nineteen percent of HLES patients had gastroesophageal reflux on pH studies. Eighty-two percent of HLES patients responded well to symptom-directed medical therapy. Two patients with esophageal body dysmotility responded well to an esophageal myotomy with a partial fundoplication. Patients with the HLES form a heterogeneous group. Gastroesophageal reflux in HLES patients is not uncommon. Patients with HLES respond well to medical therapy. Carefully selected patients require surgery.