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The hypertensive lower esophageal sphincter

N Katada1, R A Hinder, P R Hinder

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

American Journal of Surgery
|November 1, 1996
PubMed
Summary

Hypertensive lower esophageal sphincter (HLES) affects 4% of patients, presenting heterogeneously. Most HLES patients respond well to medical therapy, but some require surgery.

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Area of Science:

  • Gastroenterology
  • Esophageal Motility Disorders

Background:

  • Defines hypertensive lower esophageal sphincter (HLES).
  • Highlights surgical implications of HLES.
  • Establishes upper limit of normal resting LES pressure at 26.5 mm Hg.

Purpose of the Study:

  • To define the entity of hypertensive lower esophageal sphincter (HLES).
  • To investigate the characteristics and treatment of HLES.
  • To assess the response to medical and surgical interventions for HLES.

Main Methods:

  • Esophageal manometry on 1,300 patients.
  • Identified 53 patients (4%) with HLES.
  • Utilized 24-hour esophageal pH studies for 32 HLES patients.

Main Results:

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  • HLES patients showed diverse conditions including achalasia (26%), isolated HLES (74%), NEMD, post-Nissen fundoplication, nutcracker esophagus, and DES.
  • Gastroesophageal reflux was present in 19% of HLES patients.
  • 82% of HLES patients responded well to medical therapy; two with dysmotility improved with surgery.

Conclusions:

  • HLES patients represent a heterogeneous group with varied underlying conditions.
  • Gastroesophageal reflux is a common comorbidity in HLES.
  • Medical therapy is effective for most HLES patients, with surgery reserved for carefully selected cases.