What Is a Diffuse Esophageal Spasm?

Diffuse esophageal spasm is a primary esophageal dyskinesia disease characterized by high-pressure esophageal peristaltic abnormalities. The lesions are mainly in the lower and middle esophagus, and they appear as high, long, non-propulsive repetitive contractions. , Resulting in esophagus beaded or spiral narrow, and the upper esophagus and lower esophageal sphincter are often not affected. The disease is relatively rare in the clinic, and chronic chronic chest pain and dysphagia are the main symptoms. It can occur at any age. It is more than 50 years old and there is no obvious gender difference. The etiology and pathogenesis of this disease are not very clear. The disease is more common in people over 50 years of age, but it can occur in adults of any age. No significant gender difference.

Basic Information

English name: diffuse esophageal spasm, DES
Visiting department: surgical
Multiple groups: People over 50

Common locations: Lower middle esophagus
Common causes: Nerve and muscle degeneration of the esophagus, mental factors, mucosal irritation such as gastroesophageal reflux, esophageal candidiasis, cold food stimulation, etc.
Common symptoms: Chest pain, dysphagia, nausea, heartburn, etc.

Causes of diffuse esophageal spasm

At present, it may be related to the following factors: esophageal nerve and muscle degeneration, vagus nerve esophageal branch in some patients can be seen degenerative changes and fibrous rupture, there are also reports of vagus nerve dorsal nucleus and prespinal neuron lesions; mental factors, patients with this disease often History of trauma and often onset after emotional agitation; other factors, mucosal irritation such as gastroesophageal reflux, esophageal candidiasis, cold food stimulation, etc.

Clinical manifestations of diffuse esophageal spasm

Chest pain is the most characteristic symptom and occurs in 80% to 90% of patients. Especially in the elderly, the pain is located behind the sternum and radiates to the back and scapula, so it sometimes resembles angina. The pain can range from severe to severe, and can sometimes be relieved with anesthetics. Pain is not necessarily related to swallowing, and it can sometimes be caused by eating hot or cold fluids. Dysphagia is also common and occurs in 30% to 60% of patients. It is episodic and non-progressive, not necessarily accompanied by chest pain. It has nothing to do with eating the food. It can be difficult to swallow solid food or liquid food. Cold or hot diet is more likely to be induced. Antifeeding, a large amount of food and liquid retained in the esophagus can flow back into the mouth and nasopharynx, chest pain can be relieved after antifeeding, and it can also cause aspiration pneumonia. In addition, some patients may have heartburn symptoms.

Diffuse esophageal spasm

Esophageal manometry

It showed that the esophagus body had non-pushing, uncoordinated contraction and intermittent normal peristalsis simultaneously. The average pressure caused by this uncoordinated contraction can be similar to that caused by normal peristaltic waves, but sometimes it can be significantly increased and the duration of the contraction can be prolonged abnormally. The upper 1/3 of the esophagus functions normally, and the pressure of the LES (subesophageal sphincter) is mostly normal, but sometimes it increases.

2.X-ray inspection

No abnormal findings were found on chest radiographs. X-ray barium examination showed peristaltic waves, only reaching the level of the aortic arch, and 2/3 of the esophagus was replaced by an abnormally strong, uncoordinated, non-propulsive contraction, and the esophagus appeared. A series of narrow coaxiality causes the esophagus to be spiral or beaded. However, the severity of the patient's symptoms has no parallel relationship with the extent and extent of X-ray abnormalities. The patient was asymptomatic and was only discovered by accident when examining other diseases.

3. Solid esophagus esophagus scintigraphy

This method can be used for esophageal manometry and X-ray examination of patients with normal dysphagia. The patient was supine on a gamma camera with a computer connected, and was given 4ml of ^99m gallate and 75MBq solid gel and 15ml of water at the same time. A computer-connected plotter was used to record the transmission image of the bolus from the level of the circular cartilage to the stomach. An abnormality was observed when the bolus was stuck twice during one inspection, or the delivery time was longer than 9.7s.

4. Endoscopy

Certain organic lesions of the esophagus, such as tumors infiltrating the esophagus wall, can also produce esophageal spasm-like X-ray manifestations. Therefore, endoscopy of the esophagus and stomach must be performed before the diagnosis of diffuse esophageal spasm.

Diagnosis of diffuse esophageal spasm

Chest pain and intermittent dysphagia in the history are suspicious clues. No positive findings were found on physical examination. Endoscopy is mainly used to rule out other diseases. The diagnosis depends on X-ray examination and manometry.

Differential diagnosis of diffuse esophageal spasm

It should be distinguished from cardia achalasia, "nutcracker" esophagus and non-specific esophageal dyskinesia. Identification is mainly based on esophageal manometry.

Achalasia

Can also be manifested as dysphagia, sternum pain, and antifeeding. Esophageal barium angiography showed extreme expansion, extension and tortuosity of the esophagus, and the lower part of the expansion showed a beak-like stenosis; esophageal manometry showed that no peristaltic wave appeared in the lower 2/3 of the esophagus, and high LES pressure accompanied by poor relaxation or complete loss of relaxation.

2. "Nutcracker" esophagus

The nutcracker esophagus is characterized by a high amplitude of the esophagus, which can reach 150 to 200 mmHg, and a long-term (> 60s) peristaltic contraction, but the esophagus LES functions normally and can relax during meals.

Treatment of diffuse esophageal spasm

The treatment of diffuse esophageal spasm is first of all to make the patient understand that this is a benign lesion, so as to relieve their ideological concerns. If necessary, sedatives can be applied, especially before meals, to relax the patient's mood. Avoid cold foods and foods that are too sticky. Individual patients using nitroglycerin before meals can achieve satisfactory control of symptoms. Anticholinergics are often ineffective. In patients with severe and persistent symptoms and abnormal sphincter function, dilation therapy can be used to expand LES. A longitudinal myotomy of the entire distal esophagus can be used as a last resort to relieve symptoms. For diffuse esophageal spasm complicated by other diseases, the primary disease should still be treated.