How to interpret the findings of low motor amplitude in DES and achalasia ?
J. Janssens, G. Vantrappen (Leuven)
The distinction between typical achalasia and typical diffuse spasm is easy. Less typical cases, however, are difficult to classify.
1) Patients with a so-called vigorous achalasia have a manometric picture characterized by the presence of repetitive simultaneous contractions after swallowing. Sometimes, spontaneous simultaneous contractions, not induced by deglutition, occur as well . Attacks of cramp-like pain in these patients are probably related to strong long-lasting spontaneous contractions . Radiology may show a curling picture, but the typical achalasia picture is often seen on routine X-rays.
2) Several patients have been documented with a transition from diffuse spasm to achalasia (and will be discussed elsewhere).
3) Vantrappen et al. showed that primary esophageal motility disorders constitute a spectrum of conditions composed of achalasia (70 %), diffuse esophageal spasm (11 %), and intermediate types (19%) . The intermediate types are characterized by severe esophageal motor disorders in which either some peristalsis or some lower esophageal sphincter relaxations is preserved.
However, the question, arises whether it is of practical importance to aim at a strict classification. Although it is known that the results of pneumatic dilatations (and also of myotomy) are poorer in typical diffuse spasm than in achalasia, patients with intermediate types of esophageal motility disorders seem to benefit from dilatation in the same way as classical achalasia .
Therefore, an over strict classification may well be more artificial than real.