Diffuse esophageal spasm differential diagnosis: Difference between revisions
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* A [[hiatus hernia]] may be present below the stricture | * A [[hiatus hernia]] may be present below the stricture | ||
* Manometry shows decreased tone of lower esophageal sphincter | * [[Manometry]] shows decreased tone of lower esophageal sphincter | ||
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|[[Angina]] | |[[Angina]] | ||
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|Normal | |Normal | ||
|Normal | |Normal | ||
|ST segment elevation on ECG | |ST segment elevation on [[The electrocardiogram|ECG]] | ||
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|[[Esophageal cancer|Esophageal carcinoma]] | |[[Esophageal cancer|Esophageal carcinoma]] | ||
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* Pre-stricture dilatation | * Pre-stricture dilatation | ||
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* Endoscopy with biopsy is the most accurate test for diagnosis and tumor histology. It may be used to depict: | * [[Endoscopy]] with biopsy is the most accurate test for diagnosis and tumor histology. It may be used to depict: | ||
** Esophageal obstruction | ** Esophageal obstruction | ||
** Staging of disease | ** Staging of disease | ||
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* CT scan and PET scan of the chest and abdomen is an optional test for staging of the disease | * [[Computed tomography|CT scan]] and [[PET scan|PET]] scan of the chest and abdomen is an optional test for staging of the disease | ||
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|[[Systemic sclerosis]] | |[[Systemic sclerosis]] | ||
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* Mucosal damage | * Mucosal damage | ||
* Peptic stricture (advanced cases) | * Peptic [[stricture]] (advanced cases) | ||
|Positive serology for | |Positive serology for | ||
* Antinuclear antibodies | * Antinuclear antibodies | ||
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* Gastroscopic biopsy of gastroesophageal junction and cardia may demonstrate malignancy. | * Gastroscopic biopsy of gastroesophageal junction and cardia may demonstrate malignancy. | ||
* Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia | * Findings at [[endoscopy]], [[barium swallow]], and [[manometry]] may be indistinguishable from [[achalasia]] | ||
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|[[Chagas disease]] | |[[Chagas disease]] | ||
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* Irregular contours in the lower third | * Irregular contours in the lower third | ||
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* Ulceration | * [[Ulceration]] | ||
* Plaques and pseudomembranes | * Plaques and [[pseudomembranes]] | ||
* Tiny nodules, polypoid folds (advanced cases) | * Tiny nodules, polypoid folds (advanced cases) | ||
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* Esophagogastroduodenoscopy findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]] (due to the prolonged stasis). | * [[Esophagogastroduodenoscopy]] findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]] (due to the prolonged stasis). | ||
* Barium swallow shows the characteristic bird's beak appearance. | * Barium swallow shows the characteristic bird's beak appearance. | ||
[[Image:Acha.jpg|center|300px|thumb|Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922]] | [[Image:Acha.jpg|center|300px|thumb|Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922]] | ||
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* Retrosternal burning chest pain. | * Retrosternal burning chest pain. | ||
* Cough and hoarseness of voice. | * [[Cough]] and [[hoarseness]] of voice. | ||
* May present with complications such as strictures and dysphagia.<ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref> | * May present with complications such as [[strictures]] and [[dysphagia]].<ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref> | ||
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*Craving for for unusual items (such as ice or cold vegetables) | *Craving for for unusual items (such as ice or cold vegetables) | ||
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|Lab tests are consistent with the diagnosis of iron deficiency anemia. | |Lab tests are consistent with the diagnosis of [[iron deficiency anemia]]. | ||
Findings on an [[x-ray]] ([[barium]] [[esophagogram]]) suggestive of [[esophageal web]]/[[strictures]] associated with Plummer-Vinson syndrome appear as either: | Findings on an [[x-ray]] ([[barium]] [[esophagogram]]) suggestive of [[esophageal web]]/[[strictures]] associated with Plummer-Vinson syndrome appear as either: | ||
Revision as of 18:39, 17 November 2017
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Diffuse esophageal spasm Microchapters |
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Differentiating Diffuse esophageal spasm from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Diffuse esophageal spasm differential diagnosis On the Web |
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American Roentgen Ray Society Images of Diffuse esophageal spasm differential diagnosis |
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Risk calculators and risk factors for Diffuse esophageal spasm differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]
Overview
Diffuse esophageal spasm must be differentiated from other diseases that cause dysphagia, chest pain and weight loss such as angina, reflux esophagitis, esophageal carcinoma, systemic sclerosis, nutcracker esophagus, hypertensive LES, esophageal web/stricture, pseudoachalasia, stroke, esophageal candidiasis and Chagas disease etc.
Differential Diagnosis
Diffuse esophageal spasm must be differentiated from other diseases that cause dysphagia, chest pain and weight loss such as angina, reflux esophagitis, esophageal carcinoma, systemic sclerosis, nutcracker esophagus, hypertensive LES, esophageal web/stricture, pseudoachalasia, stroke, esophageal candidiasis and Chagas disease etc.[1][2][3][4][5][6][7][8][9][10][11]
| Disease | Signs & Symptoms | Findings on barium esophagogram | Findings on endoscopy | Other findings |
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| Reflux esophagitis |
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| Angina | Chest pain related to exertion
Dysphagia |
Normal | Normal | ST segment elevation on ECG |
| Esophageal carcinoma |
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| Systemic sclerosis |
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Positive serology for
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| Pseudoachalasia |
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| Chagas disease |
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| Pharyngitis |
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| Esophageal candidiasis |
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| Stroke |
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| Manifestations | Diagnostic tools | ||||
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| Achalasia |
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| GERD |
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| Esophageal carcinoma |
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| Esophageal stricture |
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| Plummer-Vinson syndrome | Common symptoms of Plummer-Vinson syndrome include:[9][10][11]
Less common symptoms
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Lab tests are consistent with the diagnosis of iron deficiency anemia.
Findings on an x-ray (barium esophagogram) suggestive of esophageal web/strictures associated with Plummer-Vinson syndrome appear as either:
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References
- ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
- ↑ 2.0 2.1 2.2 2.3 Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
- ↑ 3.0 3.1 Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
- ↑ 4.0 4.1 4.2 Napier KJ, Scheerer M, Misra S (2014). "Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities". World J Gastrointest Oncol. 6 (5): 112–20. doi:10.4251/wjgo.v6.i5.112. PMC 4021327. PMID 24834141.
- ↑ Matsuura H (2017). "Diffuse Esophageal Spasm: Corkscrew Esophagus". Am. J. Med. doi:10.1016/j.amjmed.2017.08.041. PMID 28943381.
- ↑ Lassen JF, Jensen TM (1992). "[Corkscrew esophagus]". Ugeskr. Laeg. (in Danish). 154 (5): 277–80. PMID 1736462.
- ↑ 7.0 7.1 Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S (2006). "Esophageal stricture: incidence, treatment patterns, and recurrence rate". Am. J. Gastroenterol. 101 (12): 2685–92. doi:10.1111/j.1572-0241.2006.00828.x. PMID 17227515.
- ↑ 8.0 8.1 Shami VM (2014). "Endoscopic management of esophageal strictures". Gastroenterol Hepatol (N Y). 10 (6): 389–91. PMC 4080876. PMID 25013392.
- ↑ 9.0 9.1 López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I (2002). "Sideropenic dysphagia in an adolescent". J. Pediatr. Gastroenterol. Nutr. 34 (1): 87–90. PMID 11753173.
- ↑ 10.0 10.1 Chisholm M (1974). "The association between webs, iron and post-cricoid carcinoma". Postgrad Med J. 50 (582): 215–9. PMC 2495558. PMID 4449772.
- ↑ 11.0 11.1 Larsson LG, Sandström A, Westling P (1975). "Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden". Cancer Res. 35 (11 Pt. 2): 3308–16. PMID 1192404.
- ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.