Diffuse esophageal spasm medical therapy

Xyz Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Xyz from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Diffuse esophageal spasm medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Diffuse esophageal spasm medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Diffuse esophageal spasm medical therapy
CDC on Diffuse esophageal spasm medical therapy
Diffuse esophageal spasm medical therapy in the news
Blogs on Diffuse esophageal spasm medical therapy
Directions to Hospitals Treating Psoriasis
Risk calculators and risk factors for Diffuse esophageal spasm medical therapy

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 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.

Diffuse esophageal spasm

• 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 (2):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).

• 2 Secondary DES (treatment of GERD)
  • 2.1 Adult
    • Preferred regimen (1): omeprazole 20mg PO q24h for 4 weeks
  • 2.2 Pediatric for =<1 year and >= 16yrs
    • 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.

• Refractory cases
  • • Cases refractory to above treatment,endoscopic injection of Botulinum toxin 100U is the next medical therapy.

Treatment algorithm

A01

B01

B02

C01

D01

D02

D03

E01

E02

E03

F01

F02