title: Olfactory stimuli provoke diffuse esophageal spasm: reversal by ipratropium bromide.
abstract: Diffuse esophageal spasm (DES) is a motor disorder of the esophageal smooth muscle characterized by multiple spontaneous contractions and by swallow-induced contractions that are of simultaneous onset, large amplitude, long duration, and repetitive occurrence. Although the pathogenesis of DES is unknown, provocative studies with cholinergic stimulation, esophageal balloon distention, or acid instillation have suggested involvement of both sensory and motor mechanisms. This report describes a patient with DES who would predictably become symptomatic with dysphagia and chest pain upon inhalation of perfume or other strong odors. Using esophageal scintigraphy to quantitate and analyze esophageal transit in this patient, we report for the first time that olfactory stimulation triggers episodes of DES and that such phenomena are mediated through the vagus nerve, because they can be ameliorated by the administration of ipratropium bromide. These observations suggest a new (sensory) pathway for the induction of DES and raise the intriguing possibility that inhaled anticholinergics may have a therapeutic role in the management of spastic esophageal motility disorders.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, California, USA.
authors.forename: G
authors.initials: G
authors.lastname: Triadafilopoulos
authors.forename: H P
authors.initials: HP
authors.lastname: Tsang
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D015155:Esophageal Spasm, Diffuse / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000627:therapeutic use*; D009812:Odorants; D010476:Perfume / Q000009:adverse effects*; D011877:Radionuclide Imaging; D013671:Technetium Tc 99m Sulfur Colloid; D014630:Vagus Nerve / Q000502:physiology*
chemical_list: D018680:Cholinergic Antagonists; D010476:Perfume; D013671:Technetium Tc 99m Sulfur Colloid; D009241:Ipratropium