Diffuse esophageal spasm medical therapy: Difference between revisions
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The mainstay of treatment for DES is medical therapy with [[Calcium channel blocker|calcium channel blockers]], and/or [[Tricyclic antidepressant|tricyclic antidepressants]]. | The mainstay of treatment for DES is medical therapy with [[Calcium channel blocker|calcium channel blockers]], and/or [[Tricyclic antidepressant|tricyclic antidepressants]]. | ||
==Medical Therapy | ==Medical Therapy== | ||
*Patients with | *Patients with DES are treated with [[calcium channel blockers]] if [[dysphagia]] is predominant , whereas patients with predominant [[chest pain]] are treated with either [[Calcium channel blocker|calcium channel blockers]] or [[Tricyclic antidepressant|tricyclic antidepressants]]. | ||
*Nitrate releasing drugs and local injection of [[Botulinum toxin|Botox]] toxin are used if above measures fail. | *Nitrate releasing drugs and local injection of [[Botulinum toxin|Botox]] toxin are used if above measures fail. | ||
*[[Proton pump inhibitor|Proton pump inhibitors]] are used in secondary DES. | *[[Proton pump inhibitor|Proton pump inhibitors]] are used in secondary DES.<ref name="pmid18005367">{{cite journal| author=Grübel C, Borovicka J, Schwizer W, Fox M, Hebbard G| title=Diffuse esophageal spasm. | journal=Am J Gastroenterol | year= 2008 | volume= 103 | issue= 2 | pages= 450-7 | pmid=18005367 | doi=10.1111/j.1572-0241.2007.01632.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18005367 }}</ref><ref name="pmid22215281">{{cite journal| author=Roman S, Kahrilas PJ| title=Distal esophageal spasm. | journal=Dysphagia | year= 2012 | volume= 27 | issue= 1 | pages= 115-23 | pmid=22215281 | doi=10.1007/s00455-011-9388-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22215281 }}</ref> | ||
===Diffuse esophageal spasm=== | ===Diffuse esophageal spasm=== | ||
'''Treatment of acute episode of DES is by [[sublingual]] [[hyoscyamine]] 0.125mg or [[Nifedipine|nifedipin]]<nowiki/>e 10mg or [[Nitroglycerin|nitroglycerine]] 0.3mg'''. | '''Treatment of acute episode of DES is by [[sublingual]] [[hyoscyamine]] 0.125mg or [[Nifedipine|nifedipin]]<nowiki/>e 10mg or [[Nitroglycerin|nitroglycerine]] 0.3mg'''. | ||
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**2.1 '''Adult''' | **2.1 '''Adult''' | ||
*** Preferred regimen (1): [[Omeprazole]] 20mg PO q24h for 4 weeks | *** Preferred regimen (1): [[Omeprazole]] 20mg PO q24h for 4 weeks | ||
**2.2 '''Pediatric | **2.2 '''Pediatric age 1 to 16years''' | ||
*** Preferred regimen (1): 5kg to <10 kg; [[Omeprazole]] 5mg PO q24h for 4 weeks | *** Preferred regimen (1): 5kg to <10 kg; [[Omeprazole]] 5mg PO q24h for 4 weeks | ||
*** 10kg to | *** 10kg to 20 kg; [[Omeprazole]] 10mg PO q24h for 4 weeks | ||
*** ≥ 20 kg | *** ≥ 20 kg: [[Omeprazole]] 20mg PO q24h for 4 weeks. | ||
* ''' Refractory cases''' | * ''' Refractory cases''' | ||
* | * In cases refractory to above treatment options, endoscopic injection of [[Botulinum]] toxin 100U is the next medical therapy. Complications of botox injection are chest pain/ heart burn, epigastric pain and rarely acute mediastinitis.<ref name="pmid27337985">{{cite journal| author=van Hoeij FB, Tack JF, Pandolfino JE, Sternbach JM, Roman S, Smout AJ et al.| title=Complications of botulinum toxin injections for treatment of esophageal motility disorders†. | journal=Dis Esophagus | year= 2017 | volume= 30 | issue= 3 | pages= 1-5 | pmid=27337985 | doi=10.1111/dote.12491 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27337985 }}</ref> | ||
==References== | ==References== | ||
Latest revision as of 14:25, 4 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]
Overview
The mainstay of treatment for DES is medical therapy with calcium channel blockers, and/or tricyclic antidepressants.
Medical Therapy
- Patients with DES are treated with calcium channel blockers if dysphagia is predominant , whereas patients with predominant chest pain are treated with either calcium channel blockers or tricyclic antidepressants.
- Nitrate releasing drugs and local injection of Botox toxin are used if above measures fail.
- Proton pump inhibitors are used in secondary DES.[1][2]
Diffuse esophageal spasm
Treatment of acute episode of DES is by sublingual hyoscyamine 0.125mg or nifedipine 10mg or nitroglycerine 0.3mg.
- 1 Primary DES
- 1.1 Adult
- Preferred regimen (1): Diltiazem 180-240 mg PO q24h for 7-10 days. (Contraindications: Hypersensitivity, AV block (2nd or 3rd degree), hypotension, acute MI)
- Preferred regimen (2): Imipramine 25-50 mg at bedtime for 14-21 days.
- Alternative regimen (1): Isosorbide 10 mg or sildenafil 50 mg PO as needed.
- 1.2 Pediatric
- Preferred regimen (1): Diltiazem 1.5-2mg/kg 50 mg/kg PO in 3-4 divided doses.
- Preferred regimen (2): Imipramine 10-25 mg PO per day at bedtime. (maximum, 50mg/day if 6 years to < 12 years and 75mg/day if = or > 12 years).
- 1.1 Adult
- 2 Secondary DES (treatment of GERD)
- 2.1 Adult
- Preferred regimen (1): Omeprazole 20mg PO q24h for 4 weeks
- 2.2 Pediatric age 1 to 16years
- Preferred regimen (1): 5kg to <10 kg; Omeprazole 5mg PO q24h for 4 weeks
- 10kg to 20 kg; Omeprazole 10mg PO q24h for 4 weeks
- ≥ 20 kg: Omeprazole 20mg PO q24h for 4 weeks.
- 2.1 Adult
- Refractory cases
- In cases refractory to above treatment options, endoscopic injection of Botulinum toxin 100U is the next medical therapy. Complications of botox injection are chest pain/ heart burn, epigastric pain and rarely acute mediastinitis.[3]
References
- ↑ Grübel C, Borovicka J, Schwizer W, Fox M, Hebbard G (2008). "Diffuse esophageal spasm". Am J Gastroenterol. 103 (2): 450–7. doi:10.1111/j.1572-0241.2007.01632.x. PMID 18005367.
- ↑ Roman S, Kahrilas PJ (2012). "Distal esophageal spasm". Dysphagia. 27 (1): 115–23. doi:10.1007/s00455-011-9388-3. PMID 22215281.
- ↑ van Hoeij FB, Tack JF, Pandolfino JE, Sternbach JM, Roman S, Smout AJ; et al. (2017). "Complications of botulinum toxin injections for treatment of esophageal motility disorders†". Dis Esophagus. 30 (3): 1–5. doi:10.1111/dote.12491. PMID 27337985.