- Hypertensive lower oesophageal sphincter
- “Oesophagogastric outflow obstruction” in Chicago classification
Defintion
- Elevated basal pressure of LOS
- Poor relaxation
- Normal peristalsis in the oesophagus differentiates this from achalasia
- Clinical:
- Chest pain
- Dysphagia
- Caused by lack of compliance of the sphincter
- Causes
- idiopathic
- secondary
- structural or medication-related
- 50% of these pts have an associated motility disorder of the oesophageal body
- Investigations - as for achalasia
- Manometry:
- ↑ LES pressure (≥ 26mmHg), relaxation incomplete (but not always)
- Normal peristalsis in oesophageal body
- Management
- Conservative
- Three-quarters of patients experiencing spontaneous resolution of symptoms over 6 months.
- Mild symptoms
- It is reasonable to observe and consider treatment if symptoms persist.
- Moderate-severe symptoms
- As for achalasia, botox, balloon dilation
- Myotomy indicated in pts not responding to medical Rx or dilation
- Lap modified Hellers myotomy (+ Dor fundoplication if normal motility)