| Theme | Lesions of Esophagogastric Junction -- Its Diagnostic and Therapeutic Strategies | |
|---|---|---|
| Title | Hypertensive Lower Esophageal Sphincter | |
| Publish Date | 2002/04 | |
| Author | Masaki Hamaguchi | Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author | Kazuhide Higuchi | Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author | Toshio Watanabe | Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author | Kazunari Tominaga | Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author | Yasuhiro Fujiwara | Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author | Tetsuo Arakawa | Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| [ Summary ] | The main mechanical 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. Disorders related to this activity cause clinical symptoms, such as dysphagia and chest pain, and induce abnormal esophageal motion syndromes. "Hypertensive lower esophageal sphincter" (HLES) is an infrequent primary esophageal motor disorder, and it is not often seen in Japan. HLES is a relatively rare abnormal esophageal condition accounting for 0.8-8.8% of patients complaining of dysphagia or chest pain and undergoing manometry for intra-esophageal pressure. The diagnosis of HLES is based mainly on manometry of intra-esophageal pressure; the conditions are (1) LES pressure, without stimulation, is over 45mmHg, (2) sufficient relaxation of LES is seen and (3) normal peristalsis is observed. Regarding the treatment for HLES, no established methods are available at present, but use of oral administrations of nitrate drugs, anti-choline drugs, smooth-muscle relaxants such as Ca-antagonists (nifedipine, etc.), H2-recepter antagonists and antacids, has been tested, and improved effects on subjective symptoms have been reported. Since the etiology of HLES has not yet been elucidated, and complications from other abnormal esophageal conditions are often found, some researchers do not regard HLES as an independent category. The pathophysiological clarification of HLES will be important in the future. |
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