What role does lower esophageal sphincter (LES) pressure play in the etiology of gastroesophageal reflux disease? What factors affect LES pressure?
What will be an ideal response?
• Normally the lower esophageal sphincter prevents reflux of gastric contents into the esophagus.
• This is accomplished by the competence of the sphincter muscle and relative pressures on either side of the sphincter.
• If LES competence is compromised or if gastric pressure is greater than esophageal pressure, then gastric contents will flow into the esophagus.
• Factors that potentially affect LES pressure include the hormones gastrin, estrogen, and progesterone; presence of hiatal hernia; presence of scleroderma, smoking, or some medications including dopamine, morphine, and theophylline; and nutritional factors.
• Foods high in fat, chocolate, spearmint, peppermint, alcohol, and caffeine have been noted to decrease LES pressure.
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