title: The hypertensive lower esophageal sphincter.
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.
authors.affiliation: Department of Surgery, Creighton University, Omaha, Nebraska, USA.
authors.forename: N
authors.initials: N
authors.lastname: Katada
authors.forename: R A
authors.initials: RA
authors.lastname: Hinder
authors.forename: P R
authors.initials: PR
authors.lastname: Hinder
authors.forename: R J
authors.initials: RJ
authors.lastname: Lund
authors.forename: G
authors.initials: G
authors.lastname: Perdikis
authors.forename: R A
authors.initials: RA
authors.lastname: Stalzer
authors.forename: T R
authors.initials: TR
authors.lastname: McGinn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015154:Esophageal Motility Disorders / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008365:Manometry; D008875:Middle Aged