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Symptomatic diffuse spasm of the esophagus
Last reviewed: 23.04.2024
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Symptomatic diffuse spasm of the esophagus (spasmodic pseudodiverticle, clear-shaped or carp-like esophagus) is a variant of motor disorders characterized by various non-impulsive and hyperdynamic contractions and increased tone of the lower esophageal sphincter.
Symptoms of diffuse spasm of the esophagus are chest pain and sometimes dysphagia. The diagnosis is established by fluoroscopy with a sip of barium or manometry. Treatment of diffuse spasm of the esophagus is difficult, but includes nitrates, blockers of Ca-channels, injections of botulinum toxin and antireflux therapy.
Disorders of esophagus motility badly correlate with symptoms; such disorders can cause different symptoms or may be asymptomatic in different groups of patients. In addition, the symptoms and disturbances of the contractile function are not associated with histopathological changes in the esophagus.
[Symptoms of diffuse spasm of the esophagus
Diffusive spasm of the esophagus usually causes pain behind the sternum with dysphagia when taking solid and liquid food. Pain can arise in a dream. Very hot or cold drinks can increase pain. Within a few years, these disorders can go to achalasia of the cardia.
Diffusive spasm of the esophagus can cause severe pain in the absence of dysphagia. This pain is often described as retrosternal, constrictive and may be associated with physical stress. The nature of such pain is sometimes difficult to differentiate from angina pectoris.
Some patients experience symptoms of diffuse spasm of the esophagus, which are combined with symptoms characteristic of achalasia and diffuse spasm. Some of these combinations have been termed active achalasia, as they are manifested by food retardation, aspiration, as in achalasia, and severe pain and spasms, as in the diffuse spasm of the esophagus.
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Diagnosis of diffuse spasm of the esophagus
Diffusive spasm of the esophagus must be differentiated from coronary ischemia. Absolute diagnosis of the disease of the esophagus based on symptoms is difficult. A fluoroscopy with a barium throat can reveal a sluggish progression of contrast and erratic, simultaneous contractions or tertiary contractions. Severe spasms can mimic the radiographic signs of a diverticulum, but vary in size and location. Manometry of the esophagus provides the most specific manifestation of spasm. Abbreviations are usually simultaneous, prolonged or multiphase and can be of very high amplitude ("esophagus such as nutcracker"). However, spasms may not be present in the study. An increase in the tone of the lower esophageal sphincter (NPS) or its persistent relaxation is observed in 30% of patients. Scintigraphy of the esophagus and provocative drug tests (eg, eudrophonium chloride 10 mg IV) were found to be of little informative.
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Treatment of diffuse spasm of the esophagus
Spasms of the esophagus are often difficult to treat, and control studies of therapeutic methods are not enough. Anticholinergic drugs, nitroglycerin and long-acting nitrates have limited success. Ca channel blockers for oral administration (eg, verapamil 80 mg 3 times a day, nifedipine 10 mg 3 times a day) can be as effective as injecting botulinus toxin into the NPS.
As a rule, the treatment of diffuse spasm of the esophagus is limited to drug therapy, but in severe cases it is possible to use pneumatic dilatation, bougie or surgical myotomy along the entire length of the esophagus.