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Diffuse oesophageal spasm: diagnosis by ambulatory 24 hour manometry
C P Barham1, D C Gotley, A Fowler
1University Department of Surgery, Bristol Royal Infirmary, UK.
Gut
|August 1, 1997
Summary
Twenty-four hour manometry is essential for diagnosing diffuse esophageal spasm (DES), effectively identifying symptomatic contractions. Standard manometry frequently misdiagnoses DES, labeling asymptomatic findings as positive.
Area of Science:
- Gastroenterology
- Esophageal Motility Disorders
- Diagnostic Techniques
Background:
- Diffuse esophageal spasm (DES) can cause intermittent chest pain and dysphagia.
- Traditional diagnosis relies on standard esophageal manometry criteria.
- The intermittent nature of symptoms suggests a need for prolonged monitoring.
Purpose of the Study:
- To evaluate 24-hour manometry's ability to detect symptomatic DES contractions.
- To compare standard manometry with 24-hour manometry for DES diagnosis.
Main Methods:
- Studied 390 consecutive patients with suspected esophageal disorders.
- Utilized both standard laboratory-based manometry and 24-hour outpatient manometry.
Main Results:
- 24-hour manometry identified 16 patients with symptomatic DES based on prolonged, high-amplitude contractions.
- Standard manometry failed to detect most DES cases (14/16) and incorrectly diagnosed 53/55 patients.
- A significant discrepancy exists between standard and 24-hour manometry findings.
Conclusions:
- 24-hour manometry is crucial for accurately detecting symptomatic diffuse esophageal spasm.
- Standard manometry is insufficient for diagnosing DES due to its intermittent nature and potential for false positives.