Functional abnormalities of the LES found by TNE. (Esophagoscopy Clinic).We summarize two cases of abnormalities of the lower esophageal sphincter lower esophageal sphincter n. A ring of smooth muscle fibers at the junction of the esophagus and stomach. Also called cardiac sphincter. (LES) that were examined by transnasal esophagoscopy (TNE). Case reports Patient 1. A 22-year-old white woman--a professional singer--was evaluated for chronic hoarseness. Laryngopharyngeal reflux injury was noted on transnasal fiberoptic laryngoscopy. On TNE, the LES was found to be incompetent, as it allowed for unimpeded passage of the esophagoscope e·soph·a·go·scope n. An endoscope for examining the interior of the esophagus. esophagoscope an endoscope for examination of the esophagus. through the gastroesophageal junction as well as obvious reflux of gastric contents into the esophagus (figure 1, A). Esophageal manometry revealed an LES pressure of 8 mmHg (normal: 10 to 45) with complete postswallow relaxation pressure at the gastric baseline (figure 1, B). A pH study detected episodes of abnormal pharyngeal pharyngeal /pha·ryn·ge·al/ (fah-rin´je-al) pertaining to the pharynx. pha·ryn·geal or pha·ryn·gal adj. Of, relating to, located in, or coming from the pharynx. reflux. Patient 2. A 47-year-old white man complained of substernal heaviness and dysphagia while eating solids. Findings on transnasal fiberoptic laryngoscopy were suggestive of laryngopharyngeal reflux. During TNE, the examiner experienced difficulty passing the scope through the tight LES despite air insufflation insufflation /in·suf·fla·tion/ (-sah-fla´shun) 1. the act of blowing a powder, vapor, or gas into a body cavity. 2. finely powdered or liquid drugs carried into the respiratory passages by such devices as aerosols. and irrigation irrigation, in agriculture, artificial watering of the land. Although used chiefly in regions with annual rainfall of less than 20 in. (51 cm), it is also used in wetter areas to grow certain crops, e.g., rice. (figure 2, A). Peristaltic peristaltic pertaining to or emanating from peristalsis. peristaltic reflex onward movement of a bolus of ingesta in the intestine is preceded by a reflex dilation of the intestine. contractions were strong and prolonged. No mucosal lesions were seen. Esophageal manometry detected a mild hypertensive resting LES pressure of 47 mmHg with incomplete relaxation at 16 mmHg residual pressure (normal relaxation pressure: <8 mmHg above the gastric baseline) and distal esophageal amplitudes greater than 180 mmHg (normal: 30 to 180) (figure 2, B). These findings were diagnostic of a "nutcracker esophagus." A 24-hour, double-probe, ambulatory pH study revealed multiple pharyngeal acid exposures. Discussion TNE is a safe in-office procedure that allows for the direct visual examination of the esophageal and gastric mucosa. With experience, the examiner can become more familiar with the nuances of sphincter tone and peristalsis peristalsis: see digestive system. peristalsis Progressive wavelike muscle contractions in the esophagus, stomach, and intestines, and sometimes in the ureters and other hollow tubes. . Experience coupled with a good clinical history makes TNE a useful tool for diagnosing esophageal motility disorders. From the Center for Voice Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org |
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