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esophageal spasm

Epidemiology: uncommon Pathology: - esophageal muscle contractions of excessive force & duration Clinical manifestations: 1) may occur spontaneously 2) may be triggered by meals, reflux, physical stress 3) pain often persists as a dull ache for hours after the attack 4) dysphagia for both liquids & solids 5) may respond to nitroglycerin or to calcium channel blockers confounding the differentiation from cardiac angina Laboratory: 1) ambulatory monitoring of intraesophageal pH & pressure 2) endoscopy may be non diagnostic 3) esophageal manometry - simultaneous contractions & intermittent normal peristalsis Radiology: - barium swallow - corkscrew esophagus caused by muliple simultaneous esophageal contractions - may be non diagnostic Differential diagnosis: 1) cardiac angina 2) erosive esophagitis 3) gastroesophageal reflux disease (GERD) 4) heartburn 5) achalasia Management: 1) empiric trial of aggressive anti-reflux measures (see GERD) 2) pharmacologic agents treatment of choice [2,3,4]; with limited effectiveness [1] a) nitrates b) Ca+2 channel blockers 3) trial of bougie dilatation

Related

chest pain esophagus gastroesophageal reflux disease (GERD)

General

esophageal dysmotility smooth muscle spasm

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, American College of Physicians, Philadelphia 1998, 2012
  2. NEJM Knowledge+ Gastroenterology
  3. Grubel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol. 2008 Feb;103(2):450-7. PMID: 18005367 Review.
  4. Goel S, Nookala V Diffuse Esophageal Spasm. NCBI Bookshelf: StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK541106/