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Hypertensive Lower Esophageal Sphincter

Hypertensive Lower Esophageal Sphincter

In this condition, the lower esophageal sphincter (LES) is hypertensive (a state of increased contraction pressures).

Causes

Hypertensive lower esophageal sphincter could be isolated (no known cause) or associated with gastroesophageal reflux disease (GERD).

Symptoms

Dysphagia (difficulty swallowing), chest pain, heartburn and regurgitation are the most common symptoms of hypertensive lower esophageal sphincter.  The symptoms usually progress slowly with time. 

Diagnosis

High-resolution manometry is the gold standard for the diagnosis of hypertensive lower esophageal sphincter. Videoesophagram and upper endoscopy are also needed to rule out other problems with similar symptoms and to help plan the treatment.

Treatment

Medical treatment

Medical treatment includes aggressive treatment of reflux disease in patients with GERD. Endoscopic treatment for hypertensive LES involves Botox® injections to relax the sphincter. Surgical treatment for symptomatic patients with hypertensive LES needs to be individualized based on associated findings such as hiatal hernia or esophageal dysmotility. 

Surgical treatment

In patients with isolated hypertensive LES, a myotomy (cutting the muscle) to relieve dysphagia, regurgitation and chest pain, and a fundoplication to prevent reflux, may be needed for a selected group of patients. The procedure can be performed by a minimally invasive approach. Follow this link to learn more about laparoscopic myotomy and Dor fundoplication.

In patients with gastroesophageal reflux disease and a hiatal hernia, repair of the hernia and a fundoplication may be necessary for relief of the symptoms of dysphagia, regurgitation and chest pain in a selected group of patients. The procedure can be done via a minimally invasive approach. Follow this link to more about the laparoscopic Nissen fundoplication.

By Farzaneh Banki, M.D.

By Michel Kafrouni, M.D.

References

1.Tamhankar AP, Almogy G, Arain MA, Portale G, Hagen JA, Peters JH, Crookes PF, Sillin LF, DeMeester SR, Bremner CG, DeMeester TR. Surgical management of hypertensive lower esophageal sphincter with dysphagia or chest pain. J Gastrointest Surg. 2003 Dec;7(8):990-6; discussion 996.