Manometric characteristics in idiopathic and reflux-associated esophageal spasm

Ancillary manometric findings, e.g., high amplitude contractions, repetitiveness, or elevated lower esophageal sphincter (LES) pressure, have been reported in diffuse esophageal spasm (DES). However, two recent changes in DES have been noted: 1) it has been redefined as increased simultaneous contractions, with intermittent peristalsis, and 2) there has been more attention to reflux-associated DES. Therefore, our aims were to characterize the ancillary findings in currently defined DES and to determine whether these occurred in both idiopathic and reflux-associated DES. Records of 31 patients with DES (greater than 25% simultaneous contractions) were reviewed. Independent of manometry, some patients could be subclassified as idiopathic (N = 7; no heartburn; normal endoscopy or acid perfusion test) or reflux-associated (N = 10; heartburn; positive endoscopy). Both low and high LES pressures and contraction amplitudes were seen. Repetitive contractions were seen in nearly all patients, and segmental aperistalsis, dropped waves, or distally nonpropagated waves were seen in more than half. These findings were generally observed in both types of DES. This study of DES 1) confirms the high prevalence of repetitive contractions, 2) deemphasizes high LES pressure and contraction amplitude, 3) extends the findings to include other types of peristaltic dysfunction, and 4) indicates that manometric findings per se do not allow clear differentiation of idiopathic from reflux-associated DES.