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Distal Esophageal Spasm

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Abstract

Distal esophageal spasm (DES) is an uncommon esophageal motility disorder associated with dysphagia and/or chest pain. Its pathophysiology implies an impairment of esophageal inhibitory neural function. Using conventional manometry, DES was defined by the presence of simultaneous esophageal contractions. With the introduction of high-resolution manometry and esophageal pressure topography (EPT) in clinical practice, rapidly propagated contractions are nonspecific of esophageal spasm. Hence, a more physiological and clinically relevant definition was proposed. Distal latency (DL) measures the period of inhibition that precedes contraction in the distal esophagus immediately proximal to the esophagogastric junction (EGJ). Premature contractions, defined as reduced DL, appeared to be much more specific for DES in EPT. Premature contractions with normal EGJ relaxation constitute DES, while premature contractions with impaired EGJ relaxation are diagnostic of spastic achalasia. Because of the interaction between DES and gastroesophageal reflux disease, 24-h esophageal pH monitoring should also be considered in patient evaluation. Medical treatment of DES aims to compensate for the deficient inhibitory neural function. Sildenafil, which blocks nitric oxide degradation and thus prolongs esophageal muscle relaxation, is a promising treatment. Endoscopic injection of botulinum toxin in the esophageal muscle is also an interesting therapeutic option. Finally, extended surgical myotomy might be discussed in extreme cases after failure of other therapeutic options.

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Abbreviations

CDP:

Contractile deceleration point

CFV:

Contractile front velocity

DES:

Distal esophageal spasm

DL:

Distal latency

EPT:

Esophageal pressure topography

EGJ:

Esophagogastric junction

GERD:

Gastroesophageal reflux disease

HRM:

High-resolution manometry

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Acknowledgment

This study was supported by Grant No. R01DK56033 (P. J. Kahrilas) from the National Institute of Health.

Disclosure

Sabine Roman has served as consultant for Given Imaging. P. J. Kahrilas has no conflicts of interest or financial ties to declare.

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Roman, S., Kahrilas, P.J. Distal Esophageal Spasm. Dysphagia 27, 115–123 (2012). https://doi.org/10.1007/s00455-011-9388-3

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  • DOI: https://doi.org/10.1007/s00455-011-9388-3

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