What is the significance of a defective LES?
- The finding of a permanently defective LES (pressure less than 6 mm Hg) has several implications. First, it is almost always associated with esophageal mucosal injury and predicts that symptoms will be difficult to control with medical therapy alone.
- A defective LES results in an increased GE junction diameter and progressively leads to loss of the acute angle of His and the development of a hiatal hernia.
- It is a signal that surgical therapy is probably needed for consistent, long-term control as the condition is irreversible, even when the associated esophagitis has healed.
- The worse the esophageal injury, the more likely it is that the LES is defective.
- Approximately 40% of patients with pH-positive GERD and no mucosal injury have a mechanically defective LES, whereas nearly 100% of patients with long-segment Barrett’s esophagus have a defective LES.
