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Diffuse Esophageal Spasm

  • Definition

    This is a condition resulting from motility disorders of the esophagus ranging from absent peristalsis to hyperperistalsis and spasm.


    Diffuse esophageal spasm typically causes substernal chest pain in association with difficulty in swallowing (dysphagia) of both liquids and solids. The pain may be severe and may awaken the patient from sleep. Liquids that are very hot or cold may aggravate the pain.

    With time, this disorder may evolve into achalasia (failure to relax smooth muscle fibers of the gastrointestinal tract). There may be reflux of recently swallowed food. Combinations of all of these with abnormal lower or upper esophageal sphincter function complete the clinical picture.

    Esophageal spasm may also produce a severe pain in the absence of dysphagia that is indistinguishable from angina pectoris. This pain is often described as a substernal squeezing pain and may occur in association with exercise.


    A specific cause is seldom found, but there may be associated reflux esophagitis (inflammation of the esophagus associated with movement of the contents of the stomach up into the esophagus).


    The abnormalities as determined by radiography or esophageal manometry (measurement of pressure) may be either symptomatic or asymptomatic.


    Esophageal spasms are difficult to treat. Anticholinergics, nitroglycerin, and long-acting nitrates have limited success. calcium channel blockers given orally (e.g., verapamil or nifedipine) may be useful in selected patients. Potent analgesics are often needed but may be habit-forming. Sublingual nitroglycerin can be effective for the acute episode, and long-acting nitroglycerin (isorbide) - or both - are often effective.

    In severe cases that are unresponsive to medical management, a long-term esophageal myotomy (surgical dissection of muscles) along the full length of the esophagus may be needed and may prove helpful.


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