Relationship Between Diffuse Esophageal Spasm and Lower Esophageal Sphincter Dysfunction on Barium Studies and Manometry in 14 Patients

Prabhakar, Anand M.; Levine, Marc S.; Rubesin, Stephen E.; Laufer, Igor; Katzka, David A.

doi:10.2214/ajr.183.2.1830409

Cited by 50 publications

(21 citation statements)

References 20 publications

(48 reference statements)

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“…However, nonperistaltic contractions might be of varying magnitude and not necessarily lumen-obliterating. In a series of 14 patients with DES on barium swallow, Prabhakar et al [24] observed a classical radiologic pattern of corkscrew esophagus in only two patients, the others exhibited nonperistaltic contractions that were not lumen-obliterating. LES dysfunction was suspected in nine patients on barium swallow.…”

Section: Barium Swallowmentioning

confidence: 99%

Distal Esophageal Spasm

Roman

Kahrilas

2012

Dysphagia

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Distal esophageal spasm (DES) is an uncommon esophageal motility disorder associated with dysphagia and/or chest pain. Its pathophysiology implies an impairment of esophageal inhibitory neural function. Using conventional manometry, DES was defined by the presence of simultaneous esophageal contractions. With the introduction of high-resolution manometry and esophageal pressure topography (EPT) in clinical practice, rapidly propagated contractions are nonspecific of esophageal spasm. Hence, a more physiological and clinically relevant definition was proposed. Distal latency (DL) measures the period of inhibition that precedes contraction in the distal esophagus immediately proximal to the esophagogastric junction (EGJ). Premature contractions, defined as reduced DL, appeared to be much more specific for DES in EPT. Premature contractions with normal EGJ relaxation constitute DES, while premature contractions with impaired EGJ relaxation are diagnostic of spastic achalasia. Because of the interaction between DES and gastroesophageal reflux disease, 24-h esophageal pH monitoring should also be considered in patient evaluation. Medical treatment of DES aims to compensate for the deficient inhibitory neural function. Sildenafil, which blocks nitric oxide degradation and thus prolongs esophageal muscle relaxation, is a promising treatment. Endoscopic injection of botulinum toxin in the esophageal muscle is also an interesting therapeutic option. Finally, extended surgical myotomy might be discussed in extreme cases after failure of other therapeutic options.

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Section: Barium Swallowmentioning

confidence: 99%

Distal Esophageal Spasm

Roman

Kahrilas

2012

Dysphagia

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“…Simultaneous smooth muscle contractions may produce a corkscrew appearance to the esophageal body along with poor esophageal clearance. However, these findings may be absent during asymptomatic periods and are not pathognomonic for DES [38][39][40]. DES was initially thought to be relatively common, with estimates of up to 10% of patients undergoing evaluation for esophageal motility disorders ultimately being diagnosed with DES [41,42].…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and medical management of esophageal dysmotility

Ravi

Katzka

2015

Techniques in Gastrointestinal Endoscopy

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“…More commonly, however, these patients have multiple nonperistaltic contractions of mild to moderate severity without a corkscrew esophagus (77). Older patients may have intermittent weakening of peristalsis in the distal esophagus and multiple nonperistaltic contractions in the absence of esophageal symptoms, a relatively common manifestation of aging known as presbyesophagus (78).…”

Section: Other Esophageal Motility Disordersmentioning

confidence: 99%

Diseases of the Esophagus: Diagnosis with Esophagography

Levine

Rubesin²

2005

Radiology

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The barium esophagram is a valuable diagnostic test for evaluating structural and functional abnormalities of the esophagus. The study is usually performed as a multiphasic examination that includes upright double-contrast views with a high-density barium suspension, prone single-contrast views with a low-density barium suspension, and, not infrequently, mucosal-relief views with either density of barium suspension. The double-contrast phase optimizes the ability to detect inflammatory or neoplastic diseases, whereas the single-contrast phase optimizes the ability to detect hiatal hernias and lower esophageal rings or strictures. Fluoroscopic examination of the esophagus is also important for assessing motility disorders such as achalasia and diffuse esophageal spasm. This article is a review of gastroesophageal reflux disease, other types of esophagitis, benign and malignant esophageal tumors, varices, lower esophageal rings, diverticula, and esophageal motility disorders, all of which can be diagnosed with the aid of esophagography.

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Relationship Between Diffuse Esophageal Spasm and Lower Esophageal Sphincter Dysfunction on Barium Studies and Manometry in 14 Patients

Cited by 50 publications

References 20 publications

Distal Esophageal Spasm

Distal Esophageal Spasm

Diagnosis and medical management of esophageal dysmotility

Diseases of the Esophagus: Diagnosis with Esophagography

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