What are the indisputable manometric criteria for making the diagnosis of diffuse esophageal spasm ?
D. Couturier (Paris)
The manometric diagnosis of the syndrome of diffuse esophageal spasm rests on
the combination of several anomalies:
The primary peristaltic waves are irregularly propagated : essentially, at least 3 out of 10 should appear simultaneously, provided the loss of peristalsis is not constant.
To this criterion, which is the most important, there is added an increase in the amplitude of the peristaltic contractions which, by our standards, should exceed 180 mmHg.
Finally, the duration of the peristaltic waves is often increased, exceeding the usual 5 seconds and often amounting to 10 to 12 seconds. - In principle, the motility of the lower esophageal sphincter is unaffected : there is no hypertonia and no achalasia.
Finally, there very probably exist intermediate forms between vigorous achalasia, where definite anomalies of the LES are present, and the syndrome of diffuse esophageal spasm.
Further, in both these syndromes, in addition to the anomalies already mentioned, repetitive waves i.e. waves which are at least triphasic, are quite frequently observed.