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Patulous lower esophageal sphincter.

A 46-year-old man presented to the Center for Voice and Swallowing with symptoms of globus, pyrosis, and solid food dysphagia. Findings on transnasal esophagoscopy were normal except for the presence of a widely patulous lower esophageal sphincter (LES) (figure). The patient exhibited no evidence of esophagitis 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.


Suggested reading

Meining A, Fackler A, Tzavella K, et al. Lower esophageal sphincter pressure in patients with gastroesophageal reflux disease 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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Author:Rees, Catherine J.; Belafsky, Peter C.
Publication:Ear, Nose and Throat Journal
Date:Aug 1, 2007
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