[Diffuse esophageal spasm (DES). Practical concepts of diagnosis and treatment].
Diffuse esophageal spasm (DES) is a motility disorder of undetermined etiology, typically presenting with chest pain, dysphagia or both. The aim of this paper is to provide a critical review of the prevalence, pathogenesis, diagnosis and therapy of DES. Data from referral centers indicates that this is a rare disorder with a prevalence of 4-7%. The diagnosis is based on the combination of typical symptoms, radiological findings and manometry (simultaneous contractions (SC) in the distal esophagus in > or = 20% of wet swallows mixed with normal peristalsis). The pathogenesis remains poorly understood. Recent evidence suggests that nitric oxide deficiency may explain the SC that characterizes this condition at manometry. Gastroesophageal reflux (GER) can coexist in DES and GER has also been implied in the pathogenesis of DES. Whether patients with DES and GER represent a subtype of DES with a different prognosis or outcome is unknown. We present a critical appraisal regarding different therapeutic approaches available for DES and conclude suggesting a management algorithm based on current available literature.
Almansa
Cristina
C
Mayo Clinic, Jacksonville, Florida, USA.
Achem
Sami René
SR
D000465:Algorithms; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002404:Catheterization; D002637:Chest Pain / Q000209:etiology; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003680:Deglutition Disorders / Q000209:etiology; D015155:Esophageal Spasm, Diffuse / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008365:Manometry; D009465:Neuromuscular Agents / Q000627:therapeutic use; D009569:Nitric Oxide / Q000172:deficiency; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011379:Prognosis; D054328:Proton Pump Inhibitors; D011859:Radiography
D000929:Antidepressive Agents, Tricyclic; D002121:Calcium Channel Blockers; D018680:Cholinergic Antagonists; D009465:Neuromuscular Agents; D010726:Phosphodiesterase Inhibitors; D054328:Proton Pump Inhibitors; D009569:Nitric Oxide; D019274:Botulinum Toxins, Type A