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Related Concept Videos

Esophageal Achalasia01:27

Esophageal Achalasia

Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide (VIP)...
Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
Gastroesophageal Reflux Disease01:25

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is the backward flow of stomach contents (acid, pepsin, or bile) into the esophagus, causing mucosal inflammation known as esophagitis. It results from failure of antireflux mechanisms, mainly the lower esophageal sphincter (LES), influenced by mechanical and physiological factors.Etiology and Risk FactorsGERD develops when LES function is weakened or when intra-abdominal pressure increases. Risk factors include aging, obesity, and sliding hiatal hernia,...
Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
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Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

Gastroesophageal Reflux Disease II: Clinical Features and Management

Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...

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Updated: May 9, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
09:40

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

Published on: April 17, 2020

Distal esophageal spasm: an update.

Sami R Achem1, Lauren B Gerson

  • 1Divisions of Gastroenterology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Achem.Sami@Mayo.edu

Current Gastroenterology Reports
|July 30, 2013
PubMed
Summary
This summary is machine-generated.

Distal esophageal spasm (DES) is a motility disorder causing chest pain and swallowing difficulty. New criteria using high-resolution esophageal pressure topography (EPT) aid diagnosis, though treatments for DES remain challenging.

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Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
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Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

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Last Updated: May 9, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
09:40

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Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
06:46

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Published on: December 14, 2020

Area of Science:

  • Gastroenterology
  • Esophageal Motility Disorders
  • Diagnostic Criteria

Background:

  • Distal esophageal spasm (DES) is characterized by chest pain and dysphagia.
  • Manometric definition involves simultaneous distal esophageal contractions (≥20% of swallows, ≥30 mmHg) alternating with normal peristalsis.
  • High-resolution esophageal pressure topography (EPT) has refined DES diagnostic criteria.

Purpose of the Study:

  • To review the current understanding and diagnostic criteria for Distal Esophageal Spasm (DES).
  • To discuss the potential etiologies, including nitric oxide deficiency and GERD.
  • To summarize the challenging treatment landscape and emerging therapeutic options for DES.

Main Methods:

  • Review of existing literature on Distal Esophageal Spasm (DES).
  • Analysis of diagnostic criteria evolution with the advent of High-Resolution Esophageal Pressure Topography (EPT).
  • Evaluation of current and potential treatment modalities for DES.

Main Results:

  • The Chicago classification updated DES criteria using EPT: ≥2 premature contractions (distal latency <4.5 s) with normal EGJ relaxation.
  • Nitric oxide (NO) deficiency is implicated in DES pathophysiology.
  • Current treatments include medications (nitrates, CCBs, etc.), dilation, botulinum toxin, Heller myotomy, and POEM, with limited high-quality trial data.

Conclusions:

  • DES diagnosis is refined by EPT criteria.
  • Etiology is multifactorial, potentially involving NO deficiency and GERD.
  • Treatment options for DES are diverse but challenging, necessitating further research, especially randomized controlled trials.