Diffuse esophageal spasm: not diffuse but distal esophageal spasm (DES)

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders
• Clinical Physiology

Background:

• Diffuse esophageal spasm (DES) is an uncommon esophageal motility disorder.
• It is characterized by simultaneous contractions in the distal esophagus.
• The term "diffuse" suggests a widespread esophageal abnormality, but its precise location is debated.

Purpose of the Study:

• To investigate the prevalence and location of simultaneous esophageal contractions in patients diagnosed with DES.
• To determine if DES affects the proximal esophagus or is limited to the distal portion.
• To clarify the terminology used for this esophageal motility disorder.

Main Methods:

• Review of esophageal manometry tracings from 53 consecutive patients diagnosed with DES.
• Comparison of DES patient data with 53 age-matched individuals with normal manometry results.
• Analysis of simultaneous contraction frequency in both proximal and distal esophageal segments.

Main Results:

• Patients with DES exhibited a high frequency of simultaneous contractions (37%) in the distal esophagus.
• Simultaneous contractions were rare in the proximal esophagus (2%), observed in only 5.6% of DES patients.
• No patients with normal manometry showed significant simultaneous contractions in either esophageal segment.

Conclusions:

• The findings indicate that simultaneous esophageal contractions in DES predominantly occur in the distal esophagus.
• The term "diffuse esophageal spasm" may be a misnomer.
• DES is more accurately described as "distal" esophageal spasm based on manometric evidence.