RefluxDoc | LES: A Tale of Two Sphincters 

Great information, thanks. Never heard about this, despite reading a lot of information about LPR from different sources. It seems, that Gerd is a complicated condition and LPR is even more so. Interesting, will we ever understand the pathophysiology behind these conditions and how to threat our LES and UES directly, without relying on PPI.

How does one determine whether the external or internal LES is the malfunctioning portion? And if it's the external sphincter (the one controlled by the vagus nerve) that has issues, does that mean the vagus nerve itself is malfunctioning? If there a fix for the nerve using medication for vagal neuropathy like amitriptyline or gabapentin?