독립된 고압성 하부식도괄약근의 임상 및 식도내압 검사소견

Abstract

Objectives: Hypertensive lower esophageal sphincter, an uncommon esophageal motility disorder, was frequently associated with the nutcracker esophagus so that it was difficult to know which motility disorder was the cause of the symptom. The present study was performed to evaluate the clinical and manometric findings of isolated hypertensive lower esophageal sphincter.

Method: The clinical findings of 14 patients with isolated hypertensive lower esophageal sphincter were studied and manometric findings were compared between 14 patients and 15 normal subjects.

Result: 14 cases among 456 cases who undertaken esophageal manometry from August, 1988 to December, 1993 were diagnosed as isolated hypertensive lower esophageal sphincter (3.1%). The average age was 44 years old, ranging from 12 to 66. Male to female ratio was 1:6. Chief complaints of the patients were dysphagia (6 cases), globus sense (3 cases), chest pain (3 cases), and epigastric pain (2 cases). The LES pressure was significantly higher in patients with isolated hypertensive lower esophageal sphincter compared to normal control subjects (49.2±3.0 mmHg vs 24.3±7.0 mmHg, p<0.001). But there were no significant differences in the nadir pressure (2.4±2.0mmHg vs 1.8±1.5 mmHg)and the amplitude of contractions at 3cm above LES (110.3 + 30. 5mmHg vs 98.7±35.4mmHg).

Conclusion: Esophageal manometric evaluation is necessary considering variable clinical manifestation of the isolated hypertensive lower esophageal sphincter. Longterm follow up studies should be taken to evaluate pathophysiologic mechanism and theraputic effect in large numbers of patients with isolated hypertensive esophageal sphincter.

Key Words: Hypertensive lower esophageal sphincter, Manometry

목적 ： 비교적 드문 일차성 식도운동질화인 HLES는 호도까지식도중과 자주 동반되므로 식도관련중상이 어 느 질환에 연유된 것인지 모호할 수 있다. 따라서 독립된 HLES(Isolated HLES)의 임상양상과 식도내압 검사소견을 조사하였다.

방법 ： 1988년 8월부터 1993년 12월까지 식도내압검사로 진단된, 독립된 HLES 환자 14예의 임상양상을 조사하고, 식도내압검사 소견을 정상대조군 15예와 비 교하였다.

결과: 독립된 HLES는 같은 기간에 식도관련 증상 으로 식도내압검사를 시행한 456명중 14예(3.1%)를 차지하였다. 나이는 12세에서 66세로 평균 44세이었고 남녀비는 1: 6으로 여자에서 훨씬 많았다. 환자의 주 증상은 연하곤란이 6예, 전흉부이물감이 3예, 흉통이 3에, 심외부통증이 2예이었다. LES압은 정상군에 비 해 유의하게 높았고 (49.2±3.0mmHg vs 24.3±7.0mmHg, p<0.001), 최 저압(2.4 ±2.mmHg vs 1.8±1.5mmHg)과 식도하부(LES상방 3cm) 수축파의 높이(110.3±30.5mmHg vs 98.7±35.4mmHg)는 유의한 차이가 없었다.

결튼:독립된 HLES의 다양한 임상양상올 볼때, 식 도내압검사의 필요성이 더욱 제기되며, 이들 환자에서 중상발현과 치료효과 둥은 더 많은 예에서 장기적으로 추적 *연구되어져야 하겠다.