The hypertensive lower esophageal sphincter(LES)(mean LES pressure>45mmHg; LES relaxation>75%;normal peristalsis) is an uncommon primary esophageal motor disorder associated with chest pain, dysphagia and globus sensation. We carried out this
study
to
evaluate clinical features, esophageal pressure profiles, endoscopic ultrasonographic findings, and assess the effect of oral nifedipine(30mg/day for 8 weeks) in patients with hypertensive LES(mean age 53.8 years, M:F=2:7) and 13 controls(mean
age
47.5
years, M:F=4:9). Chief complaints were chest pain(77.8%), dysphagia(33.3%) and globus sensation(22.2%). Esophageal manometry showed a significant(P<0.01) increase in LES pressure and higher trend of residual pressure and body contraction
amplitude
in
patients compared with controls. Two cases of nutcracker esophagus and one case of nonspecific esophageal motor disorder were associated with hypertensive LES patients by esophageal manometry. Five patients were examined by endoscopic
ultrasonography(EUS). Three of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction. Focal and/or diffuse thickening of muscularis propria were observed in remaining 2 patients. Oral nifedipine significantly
decreased
the LES pressure and alleviated most of dysphagia and chest pain in patients with normal EUS finding. In conclusion, hypertensive LES was a heterogenous esophageal motor disorder characterized by high LES pressure, residual pressure and body
contraction
amplitude. The clinical relevance of endoscopic ultrasonographic finding is yet to be determined, but it may be speculated that nifedipine's lack of effect on esophageal pressure profiles in some patients is responsible for thickening of
muscularis
propria in the area of lower esophageal sphincter. Collecting further data regarding treatment response according to EUS findings is required to validate our speculation.
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