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Functional abnormalities of the LES found by TNE. (Esophagoscopy Clinic).

We summarize two cases of abnormalities of the lower esophageal 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 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 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 and irrigation (figure 2, A). Peristaltic 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. 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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Article Details
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Title Annotation:lower esophageal sphincter, transnasal esophagoscopy
Author:Koufman, James A.
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Jul 1, 2003
Words:305
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