Diffuse Esophageal Spasm

Definition

Diffuse esophageal spasm is a term used to define an uncoordinated or spastic esophagus.

Description

The esophagus is a muscular tube that actively transports food from the throat to the stomach by rhythmic contractions known as peristalsis. The actual mechanism and anatomy are quite complex, involving three distinct segments and allowing a person to swallow even when upside-down. Diffuse esophageal spasm describes a condition where the entire esophagus is spastic—along its entire length, the muscular activity is increased and uncoordinated. The name corkscrew esophagus describes perfectly the appearance of this disorder on x rays.

X rays may reveal a slightly different appearance and result in the designation rosary bead esophagus, but the cause is still diffuse spasm, and the two entities behave in the same way.

Causes and symptoms

The cause appears to be disruption of the complex system of nerves that coordinates the muscular activity. The result is difficulty swallowing (dysphagia) and pain that feels like a heart attack and can involve the entire chest, jaw, and arms.

Diagnosis

Swallowing problems usually call for esophagograms. In the x-ray department, the patient is given a contrast agent to drink. During swallowing, x rays record the passage of the agent down the esophagus and into the stomach. Instead of a straight tube with well-coordinated waves of contraction, the resulting x rays show a writhing organ resembling a giant corkscrew.

Another test that is used in many disorders of esophageal motility is manometry. Pressures inside the esophagus are measured every inch or so using a balloon device that is passed all the way down to the stomach. The result is a precise record of its activity that yields a specific diagnosis.

KEY TERMS

Contrast agent— A substance that produces shadows on x rays.

Manometry— Measurement of pressure.

Peristalsis— Slow, rhythmic contractions of the muscles in a tubular organ, such as the intestines, that propel the contents along.

Treatment

Soft and liquid foods pass more easily than solid pieces. Medications of several types are helpful—nifedipine, hydralazine, isoproterenol, and nitrates being the most successful. Several other treatments have uncertain results. For severe cases, relief is obtained two-thirds of the time by cutting the muscles along the entire length of the esophagus. This is a major surgical procedure.

Prognosis

This condition does not go away, nor is treatment entirely satisfactory. Patients need to be careful of what they eat and continue on medication if a beneficial one is found. Fortunately, the condition does not get progressively worse as time passes.

Resources

BOOKS

Goyal, Raj K. "Diseases of the Esophagus." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.