The hypertensive lower esophageal sphincter

Am J Surg. 1996 Nov;172(5):439-42; discussion 442-3. doi: 10.1016/S0002-9610(96)00219-X.


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.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Esophageal Motility Disorders / etiology*
  • Esophageal Motility Disorders / physiopathology
  • Esophageal Motility Disorders / surgery
  • Esophagogastric Junction / physiopathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / complications*
  • Hypertension / physiopathology
  • Male
  • Manometry
  • Middle Aged