Hypertensive lower esophageal sphincter (HLES): prevalence,symptoms genesis and effect of pneumatic balloon dilatation.
BACKGROUND



BACKGROUND
The Hypertensive lower esophageal sphincter (HLES) is an unusual primary motor disorder of the esophagus. The significance of this motility disorder is still questionable.


OBJECTIVE
The objectives were: (a) identification of the prevalence of HLES in these patients, (b) identification of the common presenting symptoms of HLES, (c) study of the correlation of the symptoms with LESP and (d) study of the effectiveness of pneumatic balloon dilation in cases that fail to respond to medical treatment.


METHODS
A retrospective study that includes four thousand one hundred and seventy patients, who were subjected to esophageal manometry in the period from January 1994 to December 2003, among whom sixty-six patients with HLES (LESP> 40 mmHg) were found. In addition to manometry, upper endoscopy was done to forty-nine patients, upper GI barium studies to thirty-eight patients and esophageal pH- metry to sixteen patients.


RESULTS
showed that most of our patients were females (45 females and 21 males), with a mean age of 36.6 +/- 14 years. Patients with dysphagia (57.5%) had the highest LESP (52.1 +/- 21, mmHg) while patients with chest pain (47%) had the highest distal esophageal contraction amplitude (153.9 +/- 93.2 mmHg). Endoscopy showed varying degrees of esophagitis in 17 patients (34%). Barium studies showed corkscrew esophagus in seven patients (18.4%) and dilated esophagus in nine patients (23.7%). LESP was highest in patients with dilated esophagus (57.5 +/- 33.4 mmHg). All our patients were subjected to medical treatment, of which twelve patients underwent pneumatic dilation with successfully reduced LESP and symptoms relief in 91% of patients.


CONCLUSIONS
It was concluded that the prevalence of HLES is around 1.6, in which dysphagia and chest pain are the usual presenting symptom, and that pneumatic balloon dilatation is very effective when properly applied. It will probably occupy the same position it has in achalasia.
Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. gadelhak_n_eg@hotmail.com
Nabil A Gad
NA
El-Hak
Mohamed
M
Mostafa
Hussein
H
AbdelHamid
Magdy
M
Haleem