Diffuse esophageal spasm overview: Difference between revisions
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Diffuse or Distal esophageal spasm (DES) is an uncommon esophageal motility disorder causing chest pain and/or dysphagia. DES was first described by Osgood, in 1889 in 6 patients presenting with chest pain and dysphagia. Creamer et al. (1958) made the first manometric descriptions of DES. Development of high resolution esophageal manometry in 2000 has led to classification of esophageal motility disorders. Diffuse esophageal spasm can be classified as primary or secondary based on presence or absence of other disease associated with it. The exact pathogenesis of DES is not fully understood. Current high-resolution manometric studies suggests impairment of inhibitory neurons. These inhibitory neurons use nitric oxide (NO) as neurotransmitter. Exact cause of diffuse esophageal spasm is unknown. However, may be caused by consequence of various diseases and secondary to conditions like compression of nerves within esophageal wall, inflammation of the esophageal stricture, GERD, psychological conditions like anxiety or depression. Diffuse esophageal spasm must be differentiated from other [[diseases]] that cause [[dysphagia]], [[chest pain]] and [[weight loss]] such as [[Angina|angina,]] [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[Esophageal spasm|nutcracker esophagus]], hypertensive LES, [[Esophageal web|esophageal web/stricture]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]], [[Chagas disease]] etc. Common risk factors in the development of Diffuse Esophageal Spasm include: Age (60-80 years), obesity, mitral valve prolapse, presence of GERD, [[Hypertension]], [[anxiety]] or [[depression]], and drinks (eg. red wine, very hot or cold liquid or fluid). If left untreated, most patients are symptom free over the course of time. Very few cases report of progression to achalasia and nut cracker esophagus. The diagnostic study of choice for DES is manometry. An x-ray of esophagus after barium swallow (esophagogram) is the next best test to support manometric diagnosis. The hallmark of DES is esophageal dysphagia and chest pain. The mainstay of treatment for DES is medical therapy with [[Calcium channel blocker|calcium channel blockers]], and/or [[Tricyclic antidepressant|tricyclic antidepressants]]. | Diffuse or Distal esophageal spasm (DES) is an uncommon esophageal motility disorder causing chest pain and/or dysphagia. DES was first described by Osgood, in 1889 in 6 patients presenting with chest pain and dysphagia. Creamer et al. (1958) made the first manometric descriptions of DES. Development of high resolution esophageal manometry in 2000 has led to classification of esophageal motility disorders. Diffuse esophageal spasm can be classified as primary or secondary based on presence or absence of other disease associated with it. The exact pathogenesis of DES is not fully understood. Current high-resolution manometric studies suggests impairment of inhibitory neurons. These inhibitory neurons use nitric oxide (NO) as neurotransmitter. Exact cause of diffuse esophageal spasm is unknown. However, may be caused by consequence of various diseases and secondary to conditions like compression of nerves within esophageal wall, inflammation of the esophageal stricture, GERD, psychological conditions like anxiety or depression. Diffuse esophageal spasm must be differentiated from other [[diseases]] that cause [[dysphagia]], [[chest pain]] and [[weight loss]] such as [[Angina|angina,]] [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[Esophageal spasm|nutcracker esophagus]], hypertensive LES, [[Esophageal web|esophageal web/stricture]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]], [[Chagas disease]] etc. Common risk factors in the development of Diffuse Esophageal Spasm include: Age (60-80 years), obesity, mitral valve prolapse, presence of GERD, [[Hypertension]], [[anxiety]] or [[depression]], and drinks (eg. red wine, very hot or cold liquid or fluid). If left untreated, most patients are symptom free over the course of time. Very few cases report of progression to achalasia and nut cracker esophagus. The diagnostic study of choice for DES is manometry. An x-ray of esophagus after barium swallow (esophagogram) is the next best test to support manometric diagnosis. The hallmark of DES is esophageal dysphagia and chest pain. The mainstay of treatment for DES is medical therapy with [[Calcium channel blocker|calcium channel blockers]], and/or [[Tricyclic antidepressant|tricyclic antidepressants]]. | ||
==Historical Perspective== | ==Historical Perspective== | ||
Esophagus was described by Vasalius in 1543. Diffuse esophageal spasm was first described by Osgood in 1889. | Esophagus was described by Vasalius in 1543. Diffuse esophageal spasm was first described by Osgood in 1889 in 6 patients presenting with chest pain and dysphagia. Development of high resolution esophageal manometry in 2000 has led to classification of esophageal motility disorders. | ||
==Classification== | ==Classification== | ||
Revision as of 18:30, 28 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 overview On the Web |
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American Roentgen Ray Society Images of Diffuse esophageal spasm overview |
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Risk calculators and risk factors for Diffuse esophageal spasm overview |
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 or Distal esophageal spasm (DES) is an uncommon esophageal motility disorder causing chest pain and/or dysphagia. DES was first described by Osgood, in 1889 in 6 patients presenting with chest pain and dysphagia. Creamer et al. (1958) made the first manometric descriptions of DES. Development of high resolution esophageal manometry in 2000 has led to classification of esophageal motility disorders. Diffuse esophageal spasm can be classified as primary or secondary based on presence or absence of other disease associated with it. The exact pathogenesis of DES is not fully understood. Current high-resolution manometric studies suggests impairment of inhibitory neurons. These inhibitory neurons use nitric oxide (NO) as neurotransmitter. Exact cause of diffuse esophageal spasm is unknown. However, may be caused by consequence of various diseases and secondary to conditions like compression of nerves within esophageal wall, inflammation of the esophageal stricture, GERD, psychological conditions like anxiety or depression. 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, Chagas disease etc. Common risk factors in the development of Diffuse Esophageal Spasm include: Age (60-80 years), obesity, mitral valve prolapse, presence of GERD, Hypertension, anxiety or depression, and drinks (eg. red wine, very hot or cold liquid or fluid). If left untreated, most patients are symptom free over the course of time. Very few cases report of progression to achalasia and nut cracker esophagus. The diagnostic study of choice for DES is manometry. An x-ray of esophagus after barium swallow (esophagogram) is the next best test to support manometric diagnosis. The hallmark of DES is esophageal dysphagia and chest pain. The mainstay of treatment for DES is medical therapy with calcium channel blockers, and/or tricyclic antidepressants.
Historical Perspective
Esophagus was described by Vasalius in 1543. Diffuse esophageal spasm was first described by Osgood in 1889 in 6 patients presenting with chest pain and dysphagia. Development of high resolution esophageal manometry in 2000 has led to classification of esophageal motility disorders.