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The hypertensive lower esophageal sphincter.

AbstractBACKGROUND:
This study defines the entity of the hypertensive lower esophageal sphincter (HLES) and its treatment, including surgical implications.
METHODS:
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.
RESULTS:
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 motility 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.
CONCLUSIONS:
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.
AuthorsN Katada, R A Hinder, P R Hinder, R J Lund, G Perdikis, R A Stalzer, T R McGinn
JournalAmerican journal of surgery (Am J Surg) Vol. 172 Issue 5 Pg. 439-42; discussion 442-3 (Nov 1996) ISSN: 0002-9610 [Print] United States
PMID8942540 (Publication Type: Clinical Trial, Journal Article)
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Esophageal Motility Disorders (etiology, physiopathology, surgery)
  • Esophagogastric Junction (physiopathology)
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension (complications, physiopathology)
  • Male
  • Manometry
  • Middle Aged

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