Abstract
Stress-induced esophageal contraction abnormalities have been well documented in the literature, but relatively little is known about stress-related lower esophageal sphincter (LES) dysfunction. Two patients are described in whom initial manometry studies revealed LES hypertension and impaired LES relaxation. Both patients were markedly anxious and agitated during the initial study. However, when the manometry was repeated with the patients in a calmer state, LES pressure and function were normal. These cases demonstrate the need to be aware of stress-related LES dysfunction. If this phenomenon is not identified in the appropriate settings, it could lead to significant errors in management.
Highlights
INCREASING CLINICAL EXPERIENCE and experimental evidence suggest that psychological stressors can produce esophageal motility abnormalities [1]
Stressful interviews may produce simultaneous and repetitive contractions [2], and loud noises or difficult mental tasks performed during manometry have been shown to increase the contraction amplitude and produce simultaneous contractions in the distal esophagus of normal subjects [3,4,5]
Patients undergoing the stress of alcohol withdrawal have been observed to have hypertensive distal esophageal contractions and elevated lower esophageal sphincter (LES) pressures, which returned to normal after one month of abstinence [7]
Summary
Atypical manometric abnormality of the lower esophageal sphincter:. B INDRAKRISHNAN, WG PATERSON. When the manometry was repeated with the patients in a calmer state, LES pressure and function were normal These cases demonstrate the need to be aware of stress-related LES dysfunction. In the current report the authors describe two patients with symptoms suggestive of esophageal dysmotility in whom initial manometric studies showed hypertensive LES pressures and impaired LES relaxation. Esophageal peristalsis was again normal and only one of the 14 wet swallows resulted in a hypertensive contraction in Stress-induced LES manometric abnormalities the distal esophagus. In view of this finding, pneumatic dilation was not performed. The patient’s chest pain resolved following treatment with amitryptyline
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