Systematic review and meta-analysis on the treatment of diffuse esophageal spasm
- 01.03.2019
- original article
Erschienen in:
- verfasst von
- Harry Vercoe
- Mubashir Mulla, MD
- Wyn G. Lewis, FRCS
- Antonio Foliaki, FRCS
- David S. Y. Chan, FRCS
- Erschienen in
- European Surgery | Ausgabe 5/2019
Summary
Background
Diffuse esophageal spasm is a rare motility disorder and although diagnosis has improved over the years, optimal treatment remains controversial. The aim of this study was to determine the success rates of alternative treatments for diffuse esophageal spasm.
Methods
MEDLINE, EMBASE, and the Cochrane Library were searched for studies which reported treatment outcomes in patients with diffuse esophageal spasm. The primary outcome measure was success rate. Secondary outcome measures were morbidity and mortality.
Results
Ten observational studies involving 101 patients (35 male, 66 female, median age 61 years) with diffuse esophageal spasm treated with nifedipine (n = 24), botulinum toxin (n = 41), and surgery (n = 46) were analyzed. At a median follow-up of 8 months, the overall success rates for nifedipine, botulinum toxin, and surgery were 42.74% (95% c. i. [42.68–42.79], p < 0.00001), 74.39% (95% c. i. [74.27–74.52], p < 0.00001), and 95.74% (95% c. i. [95.69–95.80], p < 0.00001), respectively. Morbidity after surgery was 2% and no operative deaths were reported.
Conclusion
Surgery appears to be safe and the most successful treatment. The less invasive medical and botulinum toxin therapies provide short-term symptom relief.
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