Premature lower esophageal sphincter closure as a cause of dysphagia.
Impaired lower esophageal sphincter (LES) relaxation is highly correlated with dysphagia. A variation of the impaired relaxation of the LES of achalasia has been described, characterized by premature closure after normal relaxation. With a microtransducer system, standard manometric testing followed by food ingestion identified 33 patients (12 male, 21 female, 18-79 yr old) who exhibited premature LES closure. Twenty-three (70%) of these patients had a presenting complaint of dysphagia. Of these, seven (30%) experienced dysphagia during food ingestion. Manometry documented a concurrent motor abnormality in the esophageal body in 28 (85%) patients. Of the five remaining patients who did not have a concurrent motor abnormality, all had a presenting complaint of dysphagia, and three (60%) experienced dysphagia during food ingestion. The incidence of dysphagia during testing reported by patients with premature LES closure is comparable to that reported by patients with achalasia (45%) or diffuse esophageal spasm (38%) who have been studied during food ingestion in our laboratory.
Allen
M L
ML
Division of Gastroenterology, Presbyterian Medical Center of Philadelphia, University of Pennsylvania.
DiMarino
A J
AJ
Robinson
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology; D004435:Eating / Q000502:physiology; D004931:Esophageal Achalasia / Q000503:physiopathology; D015155:Esophageal Spasm, Diffuse / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009126:Muscle Relaxation