Sandbox:Madhu

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.
• In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
• In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].

Outbreaks

• There have been several outbreaks of [disease name], which are summarized below:

Landmark Events in the Development of Treatment Strategies

• In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].

Famous Cases

• The following are a few famous cases of disease name:

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. The final result being premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus.