title: Progression of diffuse esophageal spasm to achalasia: incidence and predictive factors.
abstract: The progression of certain primary esophageal motor disorders to achalasia has been documented; however, the true incidence of this decay is still elusive. This study aims to evaluate: (i) the incidence of the progression of diffuse esophageal spasm to achalasia, and (ii) predictive factors to this progression. Thirty-five patients (mean age 53 years, 80% females) with a manometric picture of diffuse esophageal spasm were followed for at least 1 year. Patients with gastroesophageal reflux disease confirmed by pH monitoring or systemic diseases that may affect esophageal motility were excluded. Esophageal manometry was repeated in all patients. Five (14%) of the patients progressed to achalasia at a mean follow-up of 2.1 (range 1-4) years. Demographic characteristics were not predictive of transition to achalasia, while dysphagia (P= 0.005) as the main symptom and the wave amplitude of simultaneous waves less than 50 mmHg (P= 0.003) were statistically significant. In conclusion, the transition of diffuse esophageal spasm to achalasia is not frequent at a 2-year follow-up. Dysphagia and simultaneous waves with low amplitude are predictive factors for this degeneration.
authors: Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Brazil. luizhsfontes@gmail.com
authors: L H S
authors: LH
authors: Fontes
authors: F A M
authors: FA
authors: Herbella
authors: T N
authors: TN
authors: Rodriguez
authors: T
authors: T
authors: Trivino
authors: J F M
authors: JF
authors: Farah
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology; D018450:Disease Progression; D004931:Esophageal Achalasia / Q000150:complications / Q000503:physiopathology*; D015155:Esophageal Spasm, Diffuse / Q000150:complications / Q000503:physiopathology*; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D006356:Heartburn / Q000209:etiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors