Management of diffuse esophageal spasm with balloon dilatation

Abstract

Of 1200 patients referred to the esophageal laboratory at Guy's Hospital for investigation of suspected esophageal motility disorders, 61 (5.1%) were diagnosed as diffuse esophageal spasm. Twenty of these patients whose symptoms were severe did not respond to conservative treatment and were treated by balloon dilatation. Results were good in 14 and poor in six patients, which included one esophageal perforation. Diffuse esophageal spasm was diagnosed where more than 30% nonperistaltic activity was demonstrated by manometry. Lower esophageal sphincter pressure and relaxation were normal in all cases except one. Gastroesophageal reflux was present in four of five poor responders who were examined by 24-h ambulatory pH monitoring, and in only one of 10 good responders. Three of the six patients in whom balloon dilatation was successful proceeded to full-length myotomy, with relief of symptoms in two. The indications for, and results of, balloon dilatation in this condition are discussed, and a new radiological sign is described.

Esophageal motility disorders (Distal esophageal spasm, nutcracker esophagus, and hypertensive lower esophageal sphincter): Modern management

“…Using the criterion of 30% nonperistaltic contractions to diagnose esophageal spasm, the authors identified and included 20 patients with esophageal spasm in a study to evaluate the effects of conventional (< 20 mm) balloon dilatation. Fourteen patients (70%) reported good clinical improvement, whereas the other six patients did not, including one esophageal perforation after balloon distention [44]. Three of the nonresponders underwent full-length myotomy, with relief of symptoms being reported in two patients.…”

“…• Irving et al [44] reported on the effects of balloon dilatation in a group of 20 patients from Guy's Hospital in London with severe symptoms that did not respond to conservative treatment. Using the criterion of 30% nonperistaltic contractions to diagnose esophageal spasm, the authors identified and included 20 patients with esophageal spasm in a study to evaluate the effects of conventional (< 20 mm) balloon dilatation.…”

Esophageal Hypomotility and Spastic Motor Disorders: Current Diagnosis and Treatment

“…Pneumatic dilation has been employed in the treatment of spastic disorders of the esophagus with some reports showing favorable results [62], but it is not known if the reported improvement was due to the inclusion of patients with achalasia.…”

Distal Esophageal Spasm

“…Although the rationale is unclear, some success has been reported in treating spastic disorders with dilation [35]. However, an important caveat to this is that it is completely uncertain as to whether patients who benefitted by pneumatic dilation would not be more properly categorized as having spastic achalasia or achalasia with esophageal compression, emphasizing the need for accurate manometric classification.…”