Varga Gabor, Kiraly Agnes, Cseke Laszlo, Kalmar Katalin, Horvath Ors Peter
Department of Surgery, Medical School, University of Pécs, Pécs, Hungary.
J Gastrointest Surg. 2008 Feb;12(2):304-7. doi: 10.1007/s11605-007-0397-3. Epub 2007 Nov 6.
For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently, the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically proven hypertensive lower esophageal sphincter was performed. Laparoscopic floppy Nissen fundoplication was performed in all cases. The first follow up was performed 6 weeks after the operation. The mean follow up time was 56 months (range 50-61). Before the operation, all patients had abnormal esophageal acid exposure. Mean DeMeester score was 41.7 (range 16.7-86). Average LES pressure before the operation was 50.5 mmHg (range 35.6-81.3). Six weeks after operation, all patients were symptom free. DeMeester score returned to a normal level of 2.9. Furthermore, a marked decrease in the lower esophageal sphincter pressure (24.7 mmHg) was detected. At late follow up, all patients were symptom-free, and only two patients agreed to undergo functional testing. The mean DeMeester score of this two patients was 1.2. The pressure remained at normal value (15.7 mmHg). In our study, an antireflux operation normalized lower esophageal sphincter pressure suggesting that abnormal esophageal acid exposure may be an etiologic factor in the development of hypertensive lower esophageal sphincter.
对于伴有吞咽困难和胸痛的高血压性食管下括约肌，推荐进行腹腔镜贲门肌切开术。最近，胃食管反流在这种异常情况中的作用已得到认可。对6例经测压证实为高血压性食管下括约肌的患者进行了一项前瞻性研究。所有病例均进行了腹腔镜松弛性nissen胃底折叠术。术后6周进行了首次随访。平均随访时间为56个月（范围50 - 61个月）。术前，所有患者食管酸暴露均异常。平均DeMeester评分为41.7（范围16.7 - 86）。术前食管下括约肌平均压力为50.5 mmHg（范围35.6 - 81.3）。术后6周，所有患者症状消失。DeMeester评分恢复到正常水平2.9。此外，检测到食管下括约肌压力显著降低（24.7 mmHg）。在后期随访中，所有患者均无症状，只有2例患者同意接受功能测试。这2例患者的平均DeMeester评分为1.2。压力维持在正常值（15.7 mmHg）。在我们的研究中，抗反流手术使食管下括约肌压力正常化，提示食管酸暴露异常可能是高血压性食管下括约肌发生的一个病因。
