Esophageal spasms
| Diffuse esophageal spasm | |
|---|---|
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| Classification and external resources | |
| Specialty | gastroenterology |
| ICD-10 | K22.4 |
| ICD-9-CM | 530.5 |
| DiseasesDB | 32060 |
| MedlinePlus | 000289 |
| eMedicine | med/743 |
| MeSH | D015155 |
Diffuse esophageal spasm (DES) is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation. In some cases, it may cause symptoms such as chest pain, similar to heart disease. The cause of DES remains unknown.
Certain abnormalities on x-ray imaging are commonly observed in DES, such as a "corkscrew" or "rosary bead esophagus", although these findings are not unique to this condition. Specialized testing called manometry can be performed to evaluate the motor function of the esophagus, which can help identify abnormal patterns of muscle contraction within the esophagus that are suggestive of DES. The treatment of DES consists primarily of medications, such as acid suppressing agents (like proton pump inhibitors), calcium channel blockers, hyoscine butylbromide, or nitrates. In only extremely rare cases, surgery may be considered. People with DES have higher incidences of gastroesophageal reflux disease (GERD) and anxiety.
DES manifests as intermittent difficulty swallowing (dysphagia) for solid foods and liquids, and atypical chest pain. The chest pain may appear similar to cardiac chest pain (angina pectoris), so investigating the possible existence of heart disease is often indicated.
Causes of diffuse esophageal spasm are not well understood. It is thought, however, that many cases are caused by uncontrolled brain signals running to nerve endings. Therefore, suppression medication is often the first line therapy such as anti depressants and anti-epileptic medication are prescribed. It has also been reported that very cold or hot beverages can trigger an esophageal spasm. Avoidance therapy benefits some people, but it has not been medically proven.
Several radiographic findings are suggestive of DES, such as a "rosary bead esophagus" or "corkscrew" appearance on barium swallow x-ray, although these findings are not unique to DES.
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