Distal esophageal spasm.A 42-year-old man presented to the Center for Voice and Swallowing with symptoms of intermittent dysphagia and substernal chest pain. Cardiac causes of the chest pain had been excluded prior to consultation. Transnasal esophagoscopy revealed intermittent nonperistaltic spasms (figure 1, A). Videofluoroscopy showed the typical corkscrew appearance of the esophagus (figure 1, B). Esophageal manometry demonstrated high-amplitude, nonperistaltic, simultaneous contractions limited to the distal two-thirds of the esophagus (figure 2). [FIGURES 1-2 OMITTED] Distal esophageal spasm (formerly known as diffuse esophageal spasm Diffuse Esophageal Spasm Definition Diffuse esophageal spasm is a term used to define an uncoordinated or spastic esophagus. Description ) affects only the smooth-muscle portion of the esophagus. It is diagnosed on esophageal manometry by the presence of simultaneous, nonperistaltic esophageal contractions in 20% or more of wet swallows. Treatment recommendations, which are based only on small studies, include proton-pump inhibitors, nitrates, tricyclic tricyclic /tri·cyc·lic/ (-sik´lik) containing three fused rings or closed chains in the molecular structure; see also under antidepressant. tricyclic containing three fused rings in the molecular structure. anti-depressants, calcium channel blockers Calcium Channel Blockers Definition Calcium channel blockers are medicines that slow the movement of calcium into the cells of the heart and blood vessels. , and serotonin reuptake inhibitors. Distal esophageal spasm may also respond to botulinum toxin injections Botulinum Toxin Injections Definition Botulinum is a bacterium (Clostridium botulinum) that produces seven different toxins that can cause botulism and is also medically used to block muscle contractions. , dilation dilation /di·la·tion/ (di-la´shun) 1. the act of dilating or stretching. 2. dilatation. di·la·tion n. 1. , or myotomy. Suggested reading Sperandio M, Tutuian R, Gideon RM, et al. Diffuse esophageal spasm: Not diffuse but distal esophageal spasm (DES). Dig Dis Sci 2003;48(7):1380-4. Tutuian R, Castell DO. Esophageal motility disorders (distal esophageal spasm, nutcracker esophagus, and hypertensive lower esophageal sphincter lower esophageal sphincter n. A ring of smooth muscle fibers at the junction of the esophagus and stomach. Also called cardiac sphincter. ): Modern management. Curr Treat Options Gastroenterol 2006;9(4):283-94. From the Center for Voice and Swallowing, University of California-Davis, Sacramento. |
|
||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion