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Distal Esophageal Spasm: A Review
Mohamed Khalaf1, Sejal Chowdhary2, Puja Sukhwani Elias1
1Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston.
The American Journal of Medicine
|April 2, 2018
Summary
Distal esophageal spasm, a rare disorder, causes difficulty swallowing and chest pain. Diagnosis requires specific manometry findings, but its intermittent nature makes definitive exclusion challenging.
Area of Science:
- Gastroenterology
- Esophageal Motility Disorders
Background:
- Distal esophageal spasm (DES) is a rare esophageal motility disorder.
- It characteristically presents with nonobstructive dysphagia and noncardiac chest pain.
Purpose of the Study:
- To characterize manometry and barium studies as complementary diagnostic tools for DES.
- To propose a treatment approach for DES, prioritizing minimally invasive interventions.
Main Methods:
- Diagnostic evaluation using esophageal manometry to identify abnormal contractions (>10% simultaneous/premature).
- Barium studies as a complementary diagnostic method.
- Assessment of treatment efficacy, starting with least invasive options.
Main Results:
- Manometric diagnosis requires >10% of wet swallows to show simultaneous and/or premature contractions with normal peristalsis.
- The intermittent nature of DES makes complete exclusion difficult, even with diagnostic testing.
- Treatment strategies are challenging and require a stepwise, minimally invasive approach.
Conclusions:
- Esophageal manometry and barium studies are valuable complementary tools for diagnosing DES.
- Complete exclusion of DES is challenging due to its intermittent presentation.
- A phased, minimally invasive treatment strategy is recommended for symptomatic patients.
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