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OESO©2015
 
Volume: Primary Motility Disorders of the Esophagus
Chapter: Diffuse esophageal spasms (Corkscrew esophagus)
 

What definition of diffuse esophageal spasm is to be observed ?

G. Vantrappen (Leuven)

Diffuse esophageal spasm is characterized by a clinical picture of substernal pain and/or dysphagia and by an esophageal motility pattern, consisting of normal peristaltic contractions after some swallows and simultaneous (tertiary) contractions of the distal half of the gullet after other swallows.

When compared to a typical case of achalasia, diffuse spasm produces a lesser degree of dysphagia, more pain and less involvement of the general condition of the patient. The non-peristaltic response in the distal half or the distal two thirds of the esophagus is characterized manometrically by non sequential pressure peaks, which may be of high amplitude and long duration, and may consist of repetitive or multipeaked waves (more than two pressure peaks in response to a single swallow). Some patients have incomplete lower esophageal sphincter relaxation whereas the basal sphincteric pressure is increased in many patients.

Other esophageal motor abnormalities occurring in diffuse esophageal pain include spontaneous activity (not induced by swallowing) and interrupted peristalsis.

Recently, Richter and Castell proposed the following manometric criteria for diffuse esophageal spasm (table 1).

Table 1. Manometric criteria for diffuse esophageal spasm

Required

Simultaneous contractions (> 10% of wet swallows)*

Intermittent normal peristalsis.

Associated findings Repetitive contractions ( ≥ 3 peaks) *

Prolonged duration of contractions (> 6 s)

Frequent spontaneous contractions

High amplitude contractions (> 190 mmHg in the distal esophagus)*

Lower esophageal sphincter abnormalities

Incomplete relaxation (< 75 %)*

High resting pressures (> 50 mmHg)*

* Abnormal values represent two standard deviations outside the mean for 50 asymptomatic volunteers.

One should not be too dogmatic in a condition which is difficult to separate from sever motility disorders such as achalasia on the one hand and from motility disorders associated with gastroesophageal reflux on the other hand.

Esophageal provocation tests and 24-hour pH and pressure recordings are sometimes required to reach a definite diagnosis.


Publication date: May 1991 OESO©2015