| Theme | Digestive Diseases to Know -- Esophagus | |
|---|---|---|
| Title | Hypertensive Lower Esophageal Sphincter | |
| Publish Date | 1998/04 | |
| Author | Takehiro Kuga | Third Department of Internal Medicine, Osaka City University Medical School |
| Author | Tetsuo Arakawa | Third Department of Internal Medicine, Osaka City University Medical School |
| [ Summary ] | The main moving function of the esophagus is to transfer ingested food to the stomach by peristalsis and to prevent retrograde flow of stomach contents by the activity of the lower sphincter. Disorder of this motion causes clinical symptoms such as dysphagia and chest pain, and induces the abnormal esophageal motion syndromes. "Hypertensive lower esophageal sphincter" (HLES) is one of them, but this concept is not widely accepted in Japan. HLES is a relatively rare abnormal esophageal motion accounting for 0.8 to 8.8% of patients who complain of dysphagia or chest pain, who underwent manometry for intra-esophageal pressure. Diagnosis of HLES is performed based mainly on manometry of intra-esophageal pressure ; the conditions are 1) LES pressure under no stimulation is more than 45mmHg, 2) sufficient relaxation of LES is seen and 3) normal peristalsis is observed. Achalasia can be distinguished from HLES because of peristalsis deficiency in the middle part of the esophagus and abnormal relaxation of LES at the time of swallowing. Regarding the treatment of HLES, no established methods are available at present, but oral administration of nitrate drugs, anti-choline drugs, smooth-muscle relaxants such as Ca-antagonists (nifedipine, etc.), H2-receptor antagonists and antacid have been tested, with improvement of subjective symptoms. Since the etiology of HLES has not yet been elucidated, and moreover, complications by other abnormal esophageal motion is found often, some researchers do not regard HLES as an independent category. Future, pathophysiological clarification of HLES appears to be important. |
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