title: Distal esophageal spasm.
abstract: OBJECTIVE
  Distal esophageal spasm (DES) is a rare esophageal motility disorder associated with dysphagia and chest pain. In 2011, the diagnosis of DES was refined based on the occurrence of premature (rather than rapid) contractions by high-resolution manometry. New therapeutic options have also been recently proposed. Thus, a review on DES incorporating publications since 2012 is timely because of these revisions in definition and management.
  
  
  RESULTS
  DES remains a heterogeneous clinical disorder. Its pathophysiology is still debated and DES might be related to achalasia. Alternatively, it might be secondary to medications, especially opiates. Endoscopic ultrasound might be informative diagnostically by demonstrating muscularis propria hypertrophy and thickening. Botulinum toxin injection in the esophageal body has been shown superior to placebo to relieve symptoms associated with DES. Finally, per oral endoscopic myotomy is a promising therapeutic approach, but may be less effective in DES than in achalasia.
  
  
  CONCLUSIONS
  The diagnosis of DES should lead to a systematic search for medication that might promote the occurrence of esophageal dysmotility. Endoscopic treatment of DES (botulinum toxin injection or per oral endoscopic myotomy) should be further evaluated in controlled studies using current diagnostic criteria by high-resolution manometry.
authors.affiliation: aDigestive Physiology, Hospices Civils de Lyon, Claude Bernard Lyon I University and LabTAU Inserm U1032, Lyon, France bDepartment of Gastroenterology, Northwestern University, Chicago, Illinois, USA.
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D019160:Endosonography / Q000379:methods; D015155:Esophageal Spasm, Diffuse / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D004947:Esophagus / Q000503:physiopathology; D006801:Humans; D008365:Manometry / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D009498:Neurotoxins / Q000627:therapeutic use
chemical_list: D009498:Neurotoxins; D001905:Botulinum Toxins