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Hypertensive lower esophageal sphincter: what does it mean?
D C Waterman1, C B Dalton, D J Ott
1Department of Medicine (Gastroenterology), Bowman Gray School of Medicine, Winston-Salem, North Carolina 27103.
Journal of Clinical Gastroenterology
|April 1, 1989
Summary
Hypertensive lower esophageal sphincter (LES) is a heterogeneous disorder. While LES pressures are high, most patients exhibit normal esophageal function, with psychological factors potentially influencing symptoms.
Area of Science:
- Gastroenterology
- Esophageal Motility Disorders
- Clinical Physiology
Background:
- The hypertensive lower esophageal sphincter (LES) is an understudied motility disorder linked to chest pain and dysphagia.
- This study investigates esophageal pressures and function in symptomatic patients with hypertensive LES.
Observation:
- Fifteen patients with hypertensive LES underwent multidisciplinary assessment.
- On-line computer analysis revealed significantly increased LES pressure and residual pressure, with reduced LES relaxation compared to controls.
- Normal peristalsis was observed in all patients, though 7 had nutcracker esophagus.
Findings:
- Esophageal liquid transport and solid emptying were largely normal.
- A majority of patients (9/12) reported elevated anxiety and somatization scores.
- A case demonstrated variable distal esophageal narrowing and transient impaction.
Implications:
- Hypertensive LES is a heterogeneous condition with diverse patient presentations.
- Abnormal LES parameters do not always correlate with impaired esophageal function.
- Psychological comorbidities may significantly contribute to symptom perception in hypertensive LES patients.