Abstract
Distal esophageal spasm is a rare motility disorder presenting principally with nonobstructive
dysphagia and noncardiac chest pain. In symptomatic patients, the manometric diagnosis
is made when >10% of the wet swallows have simultaneous and/or premature contractions
intermixed with normal peristalsis. We characterize manometry and barium as complementary
diagnostic approaches, and given the intermittent nature of the disorder, one should
be always aware that it is almost impossible to rule out spasm. Treatment is difficult;
we propose an approach beginning with the least invasive intervention.
Keywords
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References
- Classification of oesophageal motility abnormalities.Gut. 2001; 49: 145-151
- The Chicago classification of esophageal motility disorders, v3.0.Neurogastroenterol Motil. 2015; 27: 160-174
- A peculiar form of esophagismus.Boston Med Surg J. 1889; 120: 401-403
- Oesophagismus.in: Principles and Practice of Medicine. D. Appleton and Company, New York1892
- Diffuse spasm of the lower part of the esophagus.Ann Otol Rhinol Laryngol. 1934; 43 (934): 1165
- Pattern of esophageal motility in diffuse spasm.Gastroenterology. 1958; 34: 782-796
- Diffuse esophageal spasm: not diffuse but distal esophageal spasm (DES).Dig Dis Sci. 2003; 48: 1380-1384
- Symptom and function heterogenicity among patients with distal esophageal spasm: studies using combined impedance-manometry.Am J Gastroenterol. 2006; 101: 464-469
- Esophageal spasm: demographic, clinical, radiographic, and manometric features in 108 patients.Dis Esophagus. 2012; 25: 214-221
- Distal esophageal spasm: an update.Curr Gastroenterol Rep. 2013; 15: 325
- Management of spastic disorders of the esophagus.Gastroenterol Clin North Am. 2013; 42: 27-43
- Diffuse esophageal spasm: a malfunction that involves nitric oxide?.Scand J Gastroenterol. 1995; 30: 1041-1045
- The effects of recombinant human hemoglobin on esophageal motor functions in humans.Gastroenterology. 1995; 109: 1241-1248
- The effect of laparoscopic adjustable gastric bands on esophageal motility and the gastroesophageal junction: analysis using high-resolution video manometry.Obes Surg. 2009; 19: 905-914
- EGJ outflow obstruction is often associated with coexistent abnormal esophageal body motility and abnormal bolus transit.Gastroenterology. 2017; 152: S326
- Psychiatric illness and contraction abnormalities of the esophagus.N Engl J Med. 1983; 309: 1337-1342
- Esophageal motor abnormalities induced by acid perfusion in patients with heartburn.J Clin Invest. 1963; 42: 686-695
- Are esophageal motility abnormalities produced during the intraesophageal acid perfusion test?.JAMA. 1985; 253: 1914-1917
- Acid-provoked esophageal spasm as a cause of noncardiac chest pain.Am J Gastroenterol. 1991; 86: 1576-1580
- Manometric characteristics in idiopathic and reflux-associated esophageal spasm.Am J Gastroenterol. 1992; 87: 187-189
- Achalasia.Lancet. 2014; 383: 83-93
- Distal esophageal spasm.Dysphagia. 2012; 27: 115-123
- Transition from diffuse esophageal spasm to achalasia.J Clin Gastroenterol. 1979; 1: 107-117
- GERD progressing to diffuse esophageal spasm and then to achalasia.Dig Dis Sci. 2000; 45: 110-113
- Evolution of symptomatic diffuse esophageal spasm to achalasia.South Med J. 1982; 75: 217-220
- Ineffective esophageal motility progressing into distal esophageal spasm and then type III achalasia.ACG Case Rep J. 2016; 3: e183
- Does diffuse esophageal spasm progress to achalasia? A prospective cohort study.Dig Dis Sci. 2005; 50: 1605-1610
- Diffuse esophageal spasm.Am J Gastroenterol. 2008; 103: 450-457
- Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitude contractions.Dig Dis Sci. 1991; 36: 1025-1028
- Non-achalasic motor disorders of the oesophagus.Best Pract Res Clin Gastroenterol. 2007; 21: 575-593
- A case of symptomatic diffuse esophageal spasm during multiple rapid swallowing test on high-resolution manometry.J Neurogastroenterol Motil. 2010; 16: 433-436
- Diffuse esophageal spasm: has the term lost its relevance? Analysis of 217 cases.Dis Esophagus. 2011; 24: 354-359
- Diffuse esophageal spasm: a reappraisal.Ann Intern Med. 1984; 100: 242-245
- Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions.Dig Dis Sci. 1987; 32: 583-592
- Esophageal Motility Disorders: Clinical Manifestations, Diagnosis, and Management.UpToDate, Waltham, MA2017
- Diffuse esophageal spasm in the era of high-resolution manometry.Gastroenterol Hepatol (NY). 2014; 10: 130-133
- Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes.Gastroenterology. 2011; 141: 469-475
- Distal esophageal spasm and the Chicago classification: is timing everything?.Neurogastroenterol Motil. 2015; 28: 260-265
- Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report.Surg Case Rep. 2017; 3: 63
- Review article: oesophageal spasm—diagnosis and management.Aliment Pharmacol Ther. 2006; 23: 1393-1402
- Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm.N Engl J Med. 1973; 289: 23-25
- Achalasia: common features of an uncommon disease.Pract Gastroenterol. 2016;
- ACG clinical guideline: diagnosis and management of achalasia.Am J Gastroenterol. 2013; 108 (quiz 50): 1238-1249
- Sildenafil, a novel inhibitor of phosphodiesterase type 5 in human corpus cavernosum smooth muscle cells.Life Sci. 1998; 62: PL 309-PL 318
- Effect of sildenafil on oesophageal motor function in healthy subjects and patients with oesophageal motor disorders.Gut. 2002; 50: 758-764
- Imipramine in patients with chest pain despite normal coronary angiograms.N Engl J Med. 1994; 330: 1411-1417
- Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial.Gastroenterology. 1987; 92: 1027-1036
- Management of esophageal chest pain.Gastroenterol Hepatol (NY). 2007; 3: 765-767
- Peppermint oil.Am Fam Physician. 2007; 75: 1027-1030
- Peppermint oil improves the manometric findings in diffuse esophageal spasm.J Clin Gastroenterol. 2001; 33: 27-31
- Peppermint oil relieves dysphagia and non-cardiac chest pain secondary to esophageal motility disorders.Am J Gastroenterol. 2017; 112: S168-S225
- Distal esophageal spasm treated by peroral endoscopic myotomy.Am J Gastroenterol. 2012; 107: 1926-1927
- Peroral endoscopic myotomy as a platform for the treatment of spastic esophageal disorders refractory to medical therapy (with video).Gastrointest Endosc. 2014; 79: 136-139
- Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy.Gastrointest Endosc. 2013; 77: 149-150
- Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients.J Gastrointest Surg. 2015; 19 (discussion 70): 161-170
- Botulinum toxin reduces dysphagia in patients with nonachalasia primary esophageal motility disorders.Clin Gastroenterol Hepatol. 2013; 11 (e2): 1115-1121
- Achalasia: a new clinically relevant classification by high-resolution manometry.Gastroenterology. 2008; 135: 1526-1533
- Functional results after extended myotomy for diffuse oesophageal spasm.Br J Surg. 2007; 94: 1113-1118
Article info
Publication history
Published online: March 29, 2018
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: MK: Defining the topic, searching the literature, drafting the manuscript. SC: Searching the literature, drafting the manuscript. PSE: Critical revision of the manuscript for important content. DC: Critical revision of the manuscript for important content.
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