Katada N, Hinder R A, Hinder P R, Lund R J, Perdikis G, Stalzer R A, McGinn T R
Department of Surgery, Creighton University, Omaha, Nebraska, USA.
Am J Surg. 1996 Nov;172(5):439-42; discussion 442-3. doi: 10.1016/S0002-9610(96)00219-X.
This study defines the entity of the hypertensive lower esophageal sphincter (HLES) and its treatment, including surgical implications.
Esophageal manometry was performed on 1,300 patients. Of these, 53 (4%) had HLES with resting pressure > 26.5 mm Hg, defined as the upper limit of normal resting LES pressure. Thirty-two of these patients had 24-hour esophageal pH studies. The response to treatment was assessed.
Fourteen patients (26%) with HLES had achalasia. Of the remaining 39 (74%), 25 had an isolated HLES with normal esophageal body motility, 5 had a nonspecific esophageal motility disorders (NEMD), 4 were post-Nissen fundoplication, 3 had a nutcracker esophagus, and 2 had diffuse esophageal spasm (DES). Nineteen percent of HLES patients had gastroesophageal reflux on pH studies. Eighty-two percent of HLES patients responded well to symptom-directed medical therapy. Two patients with esophageal body dysmotility responded well to an esophageal myotomy with a partial fundoplication.
Patients with the HLES form a heterogeneous group. Gastroesophageal reflux in HLES patients is not uncommon. Patients with HLES respond well to medical therapy. Carefully selected patients require surgery.
本研究定义了高血压性食管下括约肌（HLES）的实体及其治疗方法，包括手术意义。
对1300例患者进行食管测压。其中，53例（4%）患有HLES，静息压力>26.5 mmHg，定义为正常静息LES压力的上限。这些患者中有32例进行了24小时食管pH值研究。评估了治疗反应。
14例（26%）HLES患者患有贲门失弛缓症。其余39例（74%）中，25例为孤立性HLES，食管体部运动正常，5例患有非特异性食管运动障碍（NEMD），4例为Nissen胃底折叠术后，3例患有胡桃夹食管，2例患有弥漫性食管痉挛（DES）。19%的HLES患者在pH值研究中有胃食管反流。82%的HLES患者对针对症状的药物治疗反应良好。2例食管体部运动障碍患者对食管肌切开术加部分胃底折叠术反应良好。
HLES患者构成一个异质性群体。HLES患者中胃食管反流并不少见。HLES患者对药物治疗反应良好。精心挑选的患者需要手术治疗。
