Is it always easy to differentiate between DES and achalasia ?
J-Y. Touchais, Ph. Ducrotte, Ph. Denis (Rouen)
From a theoretic point of view, the problem of differentiation between primary achalasia and diffuse esophageal spasm (DES) on the manometric findings does not seem to arise often. Achalasia is defined by three abnormalities of esophageal function: aperistalsis, partial or incomplete lower esophageal sphincter (LES) relaxation and increased resting LES pressure. On the other hand, the manometric criteria for the diagnosis of DES are normal resting LES pressure, normal LES relaxation, and high-amplitude, repetitive (3 waves or more) and prolonged esophageal contractions but with persistence of some normal peristaltic function.
However, in 1979, Vantrappen et al. described motor abnormalities in the esophageal body consistent with DES but associated with LES dysfunction (increased resting LES pressure and/or impaired relaxation) consistent with achalasia. They regarded esophageal abnormalities as a spectrum ranging from achalasia to classic DES . Thus, most variations in motor dysfunction can be explained, in particular that DES may evolve into achalasia in about 3 to 5 p. cent of patients . Therefore, the differential diagnosis between the two entities may be difficult.
In such cases, the persistence of some normal peristaltic function seems to be the main criterion for distinguishing DES from achalasia.