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This is accompanied by relaxation of the LES.
Poor function of the LES is responsible for most cases of GERD.
Esophageal motility studies show nonperistaltic contractions and impaired relaxation of the LES.
Diagnosis Long-term manometry of the LES using the Dent sleeve is necessary for its diagnosis.
Incomplete relaxation of the LES and elevated esophagastric pressure gradient are also demonstrated.
The unique signaling pathway may contribute to the tonic contraction of the LES.
Figure 6: Physiologic record of a spontaneous, transient relaxation of the LES.
Nitric oxide is the final mediator of the LES and diaphragmatic sphincter inhibition.
Surgical incision of the LES (Heller myotomy) performed laparoscopically has replaced that performed by open surgery.
Although there is partial inhibition of the LES, the relaxation pressures exceed 40 mmHg.
There may be atrophy of the LES smooth muscle with associated fibrosis.
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