A 50 year-old man presents to the clinic with a long history of heartburn after eating, exaggerated when he is lying down and lessened when he takes antacids. Endoscopy reveals a large irregular, erythematous area in the lower esophagus. Esophageal motility studies reveal dysfunction of the lower esophageal sphincter (LES).
Which of the following most likely leads to increase in the resting pressure of LES?
All of the choices except protein lead of relaxation of the lower esophageal sphincter. Dietary protein, histamine and antacids cause increased resting pressure of the lower esophageal sphincter and eventually improve the symptoms of GERD. On the other hand, dietary fat, alcohol, chocolate, caffeine and smoking lead to relaxation of the LES causing exaggeration of these symptoms.
The correct answer is E