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=== Pathogenesis === | === Pathogenesis === | ||
* The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neuron. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation<ref name="pmid4196712">{{cite journal| author=Orlando RC, Bozymski EM| title=Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. | journal=N Engl J Med | year= 1973 | volume= 289 | issue= 1 | pages= 23-5 | pmid=4196712 | doi=10.1056/NEJM197307052890106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4196712 }}</ref>. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus. | * The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neuron. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation<ref name="pmid4196712">{{cite journal| author=Orlando RC, Bozymski EM| title=Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. | journal=N Engl J Med | year= 1973 | volume= 289 | issue= 1 | pages= 23-5 | pmid=4196712 | doi=10.1056/NEJM197307052890106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4196712 }}</ref>. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus. | ||
References<references /> | |||
Revision as of 16:59, 29 October 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel
Historical Perspective
Discovery
- DES was first described by Osgood, in 1889 in 6 patients who presented with chest pain and dysphagia.
- Creamer (1954) made the first manometric descriptions of DES.
Classification of DES
- There is no established system for the classification of DES although it is categorized as one of the major disorders of peristalsis according to The Chicago Classification v.3.0.
Risk Factors
- Common risk factors in the development of Diffuse Esophageal Spasm include Age (60-80 years), presence of GERD, Hypertension, anxiety or depression, and drinks (eg. red wine, very hot or cold liquid or fluid).
Pathophysiology
Pathogenesis
- The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neuron. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation[1]. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus.
References
- ↑ Orlando RC, Bozymski EM (1973). "Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm". N Engl J Med. 289 (1): 23–5. doi:10.1056/NEJM197307052890106. PMID 4196712.