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Am J Surg. 1996 Nov;172(5):439-42; discussion 442-3.

The hypertensive lower esophageal sphincter.

Author information

1
Department of Surgery, Creighton University, Omaha, Nebraska, USA.

Abstract

BACKGROUND:

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.

PMID:
8942540
DOI:
10.1016/S0002-9610(96)00219-X
[Indexed for MEDLINE]

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