Hypomagnesemia and Smooth Muscle Contractility:Diffuse Esophageal Spasm in anOld Female Patient

Abstract

The aim of this paper is to describe and discuss, on the basis of the available literature, the case of an old female patient, admitted to our university hospital because of a severe dysphagia for solid foods, in whom laboratory data showed a marked hypomagnesemia. She reported a long history (20 years) of allergic bronchial asthma treated with theophylline. Esophagography evidenced a disorder of esophagus motility with diffuse multiple spasm, reminiscent of the ‘corkscrew esophagus’. A link with the severe hypomagnesemia (Mg 1.1 mEq/l, normal range 1.6–2.1) was suspected, and a therapy with oral pidolate of Mg (1.5 g/twice a day) was started and continued for 4 months. This was associated with a slow progressive normalization of the Mg plasma level and reverted radiographic esophageal findings with disappearance of dysphagia. Mg is an important element for health and disease, and today Mg deficiency in man has become an accepted medical problem which might complicate many diseases. Neuromuscular disorders, as laryngeal spasm, are recognized complications of hypomagnesemia, but until now only 1 case of motor esophageal disorder associated with a low Mg plasma level was briefly reported in the literature, even if dysphagia is generally included in the symptomatological pattern of hypomagnesemia. Our observation of a severe form of esophageal spasm, associated with hypomagnesemia, in an aged female patient underlines the pathophysiological meaning of the plasma Mg level and suggests the need for routine Mg determination in the clinical setting.

Primary renal magnesium wasting: an unusual clinical picture of exercise-induced symptoms

“…Another report describes a hypomagnesemic woman with diffuse esophageal smooth muscle spasm (DES) that recovered following magnesium supplementation (Iannello et al. ). The role of magnesium balance in IPO and DES pathophysiology has not been studied previously.…”

What’s new in the pathology, pathophysiology and management of benign esophageal disorders?

“…Similarly, Buckley et al 127 found that Schatzki rings were not as rare in children as previously thought. Esophageal motor abnormalities are reported to occur in association with a number of conditions, including diabetes, 128 scleroderma, 129 , 130 celiac disease, 131 Parkinson’s diseases, 132 the cramp–fasciculation syndrome, 133 and hypomagnesemia 134 . The presence of an air esophagogram on a conventional chest radiograph is reported to be a frequent but non‐specific sign of esophageal involvement in connective tissue diseases 135 .…”

Efficacy of magnesium in children with bronchial asthma

“…In addition, b2-mimetic use proved significantly more frequent in placebo-treated than in Mg-treated moderately asthmatic children. b-Adrenergic agonists can stimulate Mg efflux in peripheral tissues (Khilnani et al, 1992;Romani and Scarpa, 1992;Ianello et al, 1998), which can aggravate the Mg deficit of the cells indicating a certain degree of Mg depletion. Determination of the 24-h urine Mg excretion is an important and simple way to assess a Mg deficiency.…”