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Lower esophageal mucosal rings
What is the relationship of lower esophageal mucosal rings to lower esophageal sphincter pressure, abnormal gastroesophageal reflux, and hiatal hernias?
M.Y.M. Chen, D.J.Ott (Winston-Salem)
The lower esophageal mucosal ring (LEMR) is an acquired thin membrane that demarcates the esophagogastric junction, and a criterion used to diagnose hiatal hernia (Figure 1). Although the etiology of LEMR is not clear, reflux esophagitis has been proposed as a potential cause. Abnormal gastroesophageal reflux (GER) and reflux esophagitis have a multifactorial pathogenesis. However, lower esophageal sphincter dysfunction is an important cause, seen as transient or prolonged episodes of hypotension of the lower esophageal sphincter (LES) pressure. The correlation between LEMR and LES pressure, abnormal gastroesophageal reflux, and hiatal hernia is reviewed.
Correlation of LEMR and LES pressure
The lower esophageal sphincter is a high-pressure zone approximately 2-4 cm long located in the esophagogastric region. It is believed to be the major component regulating the function of the antireflux barrier. Measurement of LES pressure and its response to swallowing assesses the function of the lower esophageal sphincter and antireflux barrier. The resting LES pressure in a patient with abnormal GER is often lower than that of a normal person. Patients with persistent low LES pressure are likely to have more GER, whereas those with normal LES pressure may have less reflux. Some patients with intermittent episodes of reflux and transient sphincter dysfunction may maintain a normal resting LES pressure. Although the pathogenesis of gastroesophageal reflux disease is multifactorial, the low LES pressure may be a causative factor, and reflux esophagitis is a potential cause of LEMR.
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