title: Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitude contractions.
abstract: Diffuse esophageal spasm (DES) has frequently been described as a motility disorder characterized by simultaneous, high-amplitude contractions. We reviewed the results of esophageal manometry testing on a total of 1480 patients referred to our lab over 36 months. Lower esophageal sphincter (LES) pressure was determined by a mean of four station pull-through. Esophageal body motility was assessed following 10 wet swallows. In our lab a diagnosis of DES is made when greater than 10% but less than 100% of contractions are simultaneous. Manometric findings of DES were rare, with an overall prevalence of 4% (56/1480). Of the 56 patients with a manometric diagnosis of DES, high-amplitude (mean greater than or equal to 180 mm Hg) peristaltic contractions were found in only two (4%). No simultaneous contractions with amplitude greater than or equal to 180 mm Hg were seen. Pressures of simultaneous contractions were consistently lower than peristaltic contractions. A hypertensive LES pressure (greater than or equal to 45 mm Hg) was present in 5/56 DES patients (9%). Poor LES relaxation was found in 7/56 DES patients (13%). We conclude that DES is a rare manometric finding, regardless of the reason for referral, and that the occurrence of high-amplitude contractions in DES is equally rare.
authors.affiliation: Department of Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27103.
authors.forename: C B
authors.initials: CB
authors.lastname: Dalton
authors.forename: D O
authors.initials: DO
authors.lastname: Castell
authors.forename: E G
authors.initials: EG
authors.lastname: Hewson
authors.forename: W C
authors.initials: WC
authors.lastname: Wu
authors.forename: J E
authors.initials: JE
authors.lastname: Richter
mesh_terms: D015155:Esophageal Spasm, Diffuse / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology; D011312:Pressure; D015995:Prevalence