Sandbox:Madhu

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