Diffuse Esophageal Spasm.pdf

American Journal of Gastroenterology ISSN 0002-9270 C? 2008 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2007.01632.x Published by Blackwell Publishing Diffuse Esophageal Spasm Claudia Gru?bel, M.D.,1,2 Jan Borovicka, M.D.,2 Werner Schwizer, M.D., Prof.,3 Mark Fox, M.D.,3 Geoff Hebbard, M.D., Ph.D., Prof.1 1Department of Gastroenterology and Hepatology, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia, 2Division of Gastroenterology/Hepatology, Department of Internal Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland, and 3Division of Gastroenterology/Hepatology, University Hospital Zu?rich, Zu?rich, Switzerland The purpose of this article is to review the clinical features, pathophysiology, diagnosis, and management of patients with diffuse esophageal spasm (DES). The PubMed database was searched with a focus on recent publications, using keywords “DES,” plus “epidemiology,” “prevalence,” “diagnosis,” “pathogenesis,” “calcium channel blocker,” “nitrates,” “botulinum toxin,” “antidepressants,” “dilation,” and “myotomy.” The reference lists of papers identified in the initial PubMed search were reviewed for further relevant publications. (Am J Gastroenterol 2008;103:450–457) INTRODUCTION Retrosternal pain and dysphagia are common complaints in patients referred to gastroenterologists, either as a primary re- ferral or via cardiologic consultation. After structural lesions have been excluded by endoscopy or radiography and a trial of acid suppression to exclude contributions from gastroe- sophageal reflux disease (GERD), the underlying diagnosis is usually presumed to be a “functional” or “motility” disor- der, which may or may not be investigated further. If a de- cision is made to proceed with the investigation, esophageal manometry may reveal esophageal spasm. The question for the physician then becomes the clinical significance of the ab- normalities demonstrated, and in particular, the relationship between these findings