LES lower esophageal

GERD gastroesophageal reflux disease H2RA histamine2-receptor antagonist LES lower esophageal sphincter... 

LES Lower esophageal sphincter NIH National Institutes of Health... 

BE Barrett s esophagus ENRD endoscopy-negative reflux disease GERD gastroesophageal reflux disease LES lower esophageal sphincter NERD nonerosive reflux disease... 

In some cases, gastroesophageal reflux is associated with defective lower esophageal sphincter (LES) pressure or function. Patients may have decreased LES pressures related to spontaneous transient LES relaxations, transient increases in intraabdominal pressure, or an atonic LES. A variety of foods and medications may decrease LES pressure (Table 24-1). 

These agents increase esophageal peristaltic amplitude, increase lower esophageal sphincter (LES) pressure, and enhance gastric emptying. Cisapride also enhances small bowel and colonic motility. 

Bethanechol is a synthetic derivative of acetylcholine and is not degraded by cholinesterase. Bethanechol has been used in humans to increase lower esophageal sphincter (LES) tone and to enhance gastric emptying. The cholinergic side-effects (salivation, abdominal discomfort) of bethanechol have reduced its use in human medicine since the introduction of metoclopramide and cisapride. 

The human esophageal epithelium is a multilayered, stratified squamous epithelium. Afferent nerves are present, reaching into the superficial layers of the epithelium. With incompetence of the lower esophageal sphincter (LES), acid reflux results with consequently the possibility of pain and damage to the epithelium. 

It seems likely that TLESRs account for the majority of reflux events in normal individuals and in patients with normal LES pressure at the time of reflux. Transient lower esophageal relaxations probably represent a physiologic... 

Treatment of reflux esophagitis can be accomplished by improving the response or structure of the LES or by effective inhibition of acid secretion. Currently available compounds targeted to the LES are relatively nonselective compounds and have lower efficacy than acid inhibition. Ideally, control of GERD, in terms of both healing and symptom relief, would not allow gastric pH to fall much below 4.0 at any time. 

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