Diffuse esophageal spasm medical therapy: Difference between revisions

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Revision as of 16:22, 9 November 2017

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.

- 2.1 Refractory cases to above treatment,endoscopic injection of Botulinum toxin 100U is used.

References

Template:WH Template:WS

@@ Line 24: / Line 24: @@
 **2.1 '''Adult'''
 *** Preferred regimen (1): omeprazole 20mg PO q24h for 4 weeks
-**2.2  '''Pediatric for <1 year and > 16yrs'''
+**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.
-** 2.1 Refractory cases
+** 2.1 Refractory cases to above treatment,endoscopic injection of Botulinum toxin 100U is used.
-**: '''Note (1):'''
+**:
-**: '''Note (2)''':
-**: '''Note (3):'''
-*** 2.1.1 '''Adult'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
-**** Oral regimen
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
-*** 2.1.2 '''Pediatric'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
-**** Oral regimen
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
-** 2.2 '''Other Organ system involved 2'''
-**: '''Note (1):'''
-**: '''Note (2):'''
-**: '''Note (3):'''
-*** 2.2.1 '''Adult'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
-**** Oral regimen
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
-*** 2.2.2 '''Pediatric'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
-**** Oral regimen
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 ==References==