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Related Experiment Videos

Diffuse oesophageal spasm masking achalasia.

John Griniatsos1, Panagiotis Vlavianos, Evangelos Karvounis

  • 1Upper GI and Laparoscopic Unit, Ealing Hospital, London, United Kingdom. johngrin@hotmail.com

International Surgery
|April 17, 2004
PubMed
Summary

Diffuse esophageal spasm (DOS) may progress to achalasia following esophagomyotomy. This case suggests surgical disruption of inhibitory neurons can unmask coexisting achalasia in patients with esophageal motility disorders.

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Surgical Outcomes

Background:

  • Esophageal motility disorders, including diffuse esophageal spasm (DOS) and achalasia, are distinct conditions.
  • Progression between different esophageal motility disorders has been reported but remains incompletely understood.
  • The role of surgical intervention in potentially altering the natural history of these disorders is an area of ongoing investigation.

Observation:

  • A patient with diffuse esophageal spasm (DOS) underwent esophagomyotomy.
  • Postoperatively, the patient developed severe dysphagia, with manometry indicating achalasia.
  • The patient improved after a subsequent Heller's myotomy and Toupet's fundoplication.

Findings:

  • Esophageal manometry confirmed diffuse esophageal spasm (DOS) preoperatively.

Related Experiment Videos

  • Post-esophagomyotomy manometry revealed findings consistent with achalasia.
  • The patient's symptoms resolved after a second surgical procedure targeting achalasia.

    • Implications:

    • This case suggests that diffuse esophageal spasm (DOS) and achalasia may coexist.
    • Esophagomyotomy may disrupt inhibitory innervation in the lower esophageal sphincter (LES), unmasking underlying achalasia.
    • Understanding the complex interplay of innervation is crucial for managing esophageal motility disorders and surgical outcomes.