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Idiopathic Lower Esophageal Sphincter Incompetence and Esophageal Stricture

Arun K. Mukhopadhyay, MD
Arch Intern Med. 1980;140(11):1493-1499. doi:10.1001/archinte.1980.00330220057020.
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Under normal circumstances, the lower esophageal sphincter (LES) acts as a pressure barrier at the gastroesophageal junction. When challenged by an increase in intra-abdominal pressure, the LES pressure correspondingly increases to maintain a dynamic equilibrium that prevents gastroesophageal reflux. In spite of intensive investigation, the precise mechanisms that control LES function are not completely understood. Various drugs, hormones, and neurohumoral agents have been described that produce stimulatory or inhibitory effects on the LES. Most neurohumoral agents and exogenously administered drugs produce their effects by binding with specific receptors.1

RECEPTORS IN THE LES  Many receptors may modify LES tension. Depending on the nature of the receptor and its interrelationship with the intrinsic neurons and the smooth muscle of the LES, a receptor can mediate either stimulation or inhibition of LES tone. The receptors in the LES are located either directly on the smooth muscle or on the neural structures adjacent


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