Patulous lower esophageal sphincter.A 46-year-old man presented to the Center for Voice and Swallowing with symptoms of globus, pyrosis pyrosis: see heartburn. , and solid food dysphagia. Findings on transnasal esophagoscopy were normal except for the presence of a widely patulous patulous /pat·u·lous/ (pat´u-lus) spread widely apart; open; distended. pat·u·lous adj. Freely open or exposed; patent. patulous spread widely apart; open; distended. 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) (figure). The patient exhibited no evidence of esophagitis esophagitis /esoph·a·gi·tis/ (e-sof?ah-ji´tis) inflammation of the esophagus. chronic peptic esophagitis reflux e. or Barrett metaplasia. The LES is typically closed at rest. A wide-open patulous LES predisposes the patient to severe gastroesophageal reflux, especially in the supine position. LES incompetence may also be associated with hiatal hernia. The patient's symptoms were poorly controlled with antireflux medication, and he was referred for laparoscopic Nissen fundoplication. [FIGURE OMITTED] Suggested reading Meining A, Fackler A, Tzavella K, et al. Lower esophageal sphincter pressure in patients with gastroesophageal reflux disease gastroesophageal reflux disease (GERD) Disorder characterized by frequent passage of gastric contents from the stomach back into the esophagus. Symptoms of GERD may include heartburn, coughing, frequent clearing of the throat, and difficulty in swallowing. and posture and time patterns. Dis Esophagus 2004; 17(2): 155-8. Sloan S, Rademaker AW, Kahrilas PJ. Determinants of gastroesophageal junction incompetence: Hiatal hernia, lower esophageal sphincter, or both? Ann Intern Med 1992; 117(12): 977-82. Catherine J. Rees, MD; Peter C. Belafsky, MD, PhD From the Center for Voice and Swallowing, University of California-Davis, Sacramento. |
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