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Management of diffuse esophageal spasm with balloon dilatation
J D Irving1, W J Owen, J Linsell
1Department of Radiology, Guy's Hospital, London, UK.
Gastrointestinal Radiology
|January 1, 1992
Summary
Diffuse esophageal spasm (DES) affects 5.1% of patients with esophageal motility disorders. Balloon dilatation offers a treatment option for severe DES, with good outcomes in 70% of cases, though complications like perforation can occur.
Area of Science:
- Gastroenterology
- Esophageal Physiology
- Surgical Interventions
Background:
- Esophageal motility disorders are a common reason for referral to specialized centers.
- Diffuse esophageal spasm (DES) is a specific diagnosis within esophageal motility disorders.
- Conservative treatments for severe DES are often ineffective.
Purpose of the Study:
- To determine the efficacy and safety of balloon dilatation for diffuse esophageal spasm.
- To investigate factors influencing treatment outcomes in DES patients.
- To describe a novel radiological sign associated with DES.
Main Methods:
- Manometric assessment to diagnose DES (defined as >30% non-peristaltic activity).
- Treatment of severe, refractory DES cases with balloon dilatation.
- 24-h ambulatory pH monitoring in a subset of patients to assess gastroesophageal reflux.
- Surgical myotomy in patients who underwent successful balloon dilatation.
Main Results:
- Diffuse esophageal spasm was diagnosed in 61 out of 1200 referred patients (5.1%).
- Balloon dilatation was performed on 20 patients with severe DES, yielding good results in 14 (70%) and poor results in six (30%), including one esophageal perforation.
- Gastroesophageal reflux was more prevalent in poor responders (4/5) compared to good responders (1/10).
- Two of three patients who underwent myotomy after balloon dilatation experienced symptom relief.
Conclusions:
- Balloon dilatation is an effective treatment for selected patients with severe diffuse esophageal spasm.
- Gastroesophageal reflux may be a contributing factor in poor treatment responses.
- Further investigation into radiological signs and surgical options for DES is warranted.