Esophageal Manometric and Endoscopic Ultrasonographic Findings in Hypertensive Lower Esophageal Sphincter

Park, In Suh; Chung, Jae Bock; Park, Hyo Jin; Lee, Yong Chan

Abstract

The hypertensive lower esophageal sphincter(LES)(mean LES pressure>45mmHg; LES relaxation>75%;normal peristalsis) is an uncommon primary esophageal motor disorder associated with chest pain, dysphagia and globus sensation. We carried out this study to evaluate clinical features, esophageal pressure profiles, endoscopic ultrasonographic findings, and assess the effect of oral nifedipine(30 mg/day for 8 weeks) in patients with hypertensive LES(mean age 53.8 years, M: F:=2:7) and l3 controls(mean age 47.5 years, M:F=4:9), Chief complaints were chest pain(77.8%), dysphagia(33.3%) and globus sensation(22.2%). Esophageal manometry showed a significant(p<0.01) increase in LES pressure and higher trend of residual pressure and body contraction amplitude in patients compared with controls. Two cases of nutcracker esophagus and one case of nonspecific esophageal motor disorder were associated with hypertensive LES patients by eeophageal manometry. Five patients were examined by endoscopic ultrasonography(EUS). Three of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction. Focal and/ or diffuse thickening of muscularis propria were observed in remaining 2 patients. Oral nifedipine significantly decreased the LES pressure and alleviated most of dysphagia and chest pain in patients with normal EUS finding. In conclusion, hypertensive LES was a heterogenous esophageal motor disorder characterized by high LES pressure, residual pressure and body contraction amplitude. The clinical relevance of endoscopic ultrasonographic finding is yet to be determined, but it may be speculated that nifedipines lack of effect on esophageal pressure profiles in some patients is responsible for thickening of muscularis propria in the area of lower esophageal sphincter. Collecting further data regarding treatment response according to EUS finding is required to validate our speculation.