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.
Subject(s)
Esophageal Motility Disorders/etiology , Esophagogastric Junction/physiopathology , Hypertension/complications , Adolescent , Adult , Aged , Aged, 80 and over , Esophageal Motility Disorders/physiopathology , Esophageal Motility Disorders/surgery , Female , Follow-Up Studies , Humans , Hypertension/physiopathology , Male , Manometry , Middle AgedABSTRACT
Anorectal dysfunction can be an extreme embarrassment and inconvenience to persons afflicted with the condition, disrupting their lifestyle. Evaluation of the anal sphincter and the distinction between muscular and neural etiology is essential. Three-dimensional imaging of the anal sphincter by use of anorectal manometry with an eight-port perfused catheter combined with computer analysis aids in defining anal sphincter function. The use of three-dimensional imaging is valuable to the physician in the determination of the presence of a muscular defect, the location of the defect and the appropriateness of surgical intervention to resolve the anal dysfunction.
