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Lower esophageal sphincter dysfunction in diffuse esophageal spasm.

S Campo1, M Traube

  • 1Gastroenterology Unit, Yale University School of Medicine, New Haven, Connecticut.

The American Journal of Gastroenterology
|August 1, 1989
PubMed
Summary
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Lower esophageal sphincter (LES) dysfunction is common in diffuse esophageal spasm (DES). Reflux-associated spasm (R-DES) shows greater LES relaxation impairment than idiopathic spasm (I-DES), affecting both amplitude and duration.

Area of Science:

  • Gastroenterology
  • Esophageal Motility Disorders
  • Sphincter Function

Background:

  • Lower esophageal sphincter (LES) dysfunction is recognized in diffuse esophageal spasm (DES).
  • Evolving manometric criteria necessitate reassessment of LES relaxation in spasm.
  • LES relaxation in reflux-associated spasm (R-DES) remains underreported.

Purpose of the Study:

  • To evaluate and compare LES relaxation in idiopathic (I-DES) and reflux-associated spasm (R-DES) patients.
  • To investigate the characteristics of LES relaxation impairment in different DES subtypes.
  • To explore potential mechanisms of LES dysfunction in R-DES.

Main Methods:

  • Clinical criteria assigned 22 spasm patients into I-DES (N=9) and R-DES (N=13) groups.
  • Control groups included patients with chest pain (C-NL, N=10) and reflux (R-NL, N=10) with normal peristalsis.

Related Experiment Videos

  • Esophageal manometry assessed LES relaxation parameters: percent relaxation, nadir pressure, and duration.

    • Main Results:

    • Both I-DES and R-DES groups exhibited significantly reduced percent LES relaxation compared to controls.
    • R-DES showed significantly lower percent relaxation and higher post-deglutitive nadir sphincter pressure than I-DES.
    • While I-DES had normal relaxation duration, R-DES demonstrated significantly decreased duration, indicating greater impairment.

    Conclusions:

    • LES relaxation is impaired in I-DES, primarily affecting relaxation amplitude (percent relaxation and nadir pressure).
    • R-DES exhibits more severe LES relaxation impairment than I-DES, impacting both amplitude and duration.
    • A spectrum of LES dysfunction exists in esophageal spasm, with distinct mechanisms potentially underlying R-DES, including impaired relaxation or transient complete relaxation facilitating reflux.