Diffuse esophageal spasm overview
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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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Diffuse esophageal spasm overview On the Web |
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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.
Esophagus was described by Vasalius in 1543. Diffuse esophageal spasm was first described by Osgood in 1889.
There is no established system for the classification of DES.
The exact pathogenesis of DES is not fully understood.
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 and 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 patient are symptom free over the course of time. Very few case 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.