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Lower Esophageal Sphincter (LES)

The lower esophageal sphincter (LES) is a circular band of muscle surrounding the esophagus at its lower end. It should be in a state of continual contraction, relaxing only momentarily to allow food to pass into the stomach. Given that the muscle should immediately contract again once food or liquid has passed through, it serves as a “one-way valve,” letting food and liquid pass down into the stomach, but not from the stomach back up into the esophagus.

If the LES fails to remain adequately contracted, it can allow for acid reflux, leading to gastroesophageal reflux disease (GERD) or laryngopharynx reflux disease (LPRD). Alternately, if the muscle fails to relax appropriately when food or liquid reaches it en route to the stomach, the person has a condition called achalasia.

In R-CPD, Esophageal Findings May Correlate with Symptoms

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Distended Esophagus

Distended upper esophagus (1 of 4)

Just below the cricopharyngeus muscle, one already sees the tracheal mound (T) and spine contour (S). And the swallowed air that cannot be burped out is stretching the esophagus in the only direction possible: laterally (arrows).
Distended mid-esophagus due to R-CPD

Distended mid-esophagus (2 of 4)

Now in mid-esophagus, un-burped (not insufflated) air maintains the “always open” view, showing not only tracheal mound (T) and spine (S), but also aortic shelf (A) and in the distance, the left mainstem bronchus (B).
distended left-mainstem bronchus due to R-CPD

Left-mainstem bronchus (3 of 4)

A closer view of the left mainstem bronchus shows its ridged, segmental construction. Just below, in the darkness, is the posterior wall of the heart (H).
View includes open lower esophageal sphincter due to trapped unburpable air.

View includes open lower esophageal sphincter (4 of 4)

With our small-caliber ENT scope inserted to its limit, the beating heart (H) is seen more clearly, and in the far distance, the open entrance to the stomach (white dot) is seen, due to lower esophageal sphincter incompetence from years of unrelieved air pressure. This explains her common acid reflux symptoms.
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