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Digestive Diseases and Sciences

, Volume 41, Issue 7, pp 1346–1349 | Cite as

Manometric diagnosis of diffuse esophageal spasm

  • Melvin L. Allen
  • Anthony J. DiMarinoJr
Esophageal, Gastric, And Duodenal Disorders

Abstract

There are no requirements concerning the amplitude of simultaneous contractions among the present criteria for the manometric diagnosis of diffuse esophageal spasm. The purpose of this investigation was to determine whether the current criteria effectively identify an appropriately homogeneous patient population. Sixty consecutive motility tracings that met the criteria for diffuse esophageal spasm were evaluated. A bimodal distribution of the highest simultaneous esophageal contraction for each patient was observed. One group's (N=29) highest simultaneous esophageal contractile amplitude was ≤74 mm Hg, the other's (N=31) highest simultaneous esophageal contractile amplitude was ≥100 mm Hg. Group 1 had significantly decreased lower esophageal sphincter pressure, lower peristaltic amplitude, more aperistalsis, fewer simultaneous contractions, and fewer complaints of chest pain. These comparisons suggest that consideration be given to the amplitude of simultaneous esophageal contractions in the manometric diagnosis of diffuse esophageal spasm.

Key words

diffuse esophageal spasm manometry esophageal contractile amplitude 

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References

  1. 1.
    Richter JE, Castell DO: Diffuse esophageal spasm: A reappraisal. Ann Intern Med 100:242–245, 1984Google Scholar
  2. 2.
    Katz PO, Castell DO: Review: Esophageal motility disorders. Am J Med Sci 290:61–69, 1985Google Scholar
  3. 3.
    Blackwell JN, Holt S, Heading RC: Effect of nifedipine on oesophageal motility and gastric emptying. Digestion 21:50–56, 1981Google Scholar
  4. 4.
    Mellow MH: Effect of isosorbide and hydralazine in painful primary esophageal motility disorders. Gastroenterology 83:364–370, 1982Google Scholar
  5. 5.
    Decktor DL, Allen ML, Robinson M: Esophageal motility, heartburn, and gastroesophageal reflux: Variations in clinical presentation of esophageal dysphagia. Dysphagia 5:211–215, 1990Google Scholar
  6. 6.
    Castell JA, Gideon M, Castell DO: Esophagus.In Atlas of Gastrointestinal Motility in Health and Disease. MM Schuster (ed). Baltimore, Williams and Wilkins, 1993Google Scholar
  7. 7.
    Bennett JR, Hendrix TR: Diffuse esophageal spasm: A disorder with more than one cause. Gastroenterology 59:273–279, 1970Google Scholar
  8. 8.
    Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie D: Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980Google Scholar
  9. 9.
    Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS: Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:1547–1552, 1982Google Scholar
  10. 10.
    Mittal RK, McCallum RW: Characteristics of transient lower esophageal sphincter relaxation in humans. Am J Physiol 252:636–641, 1987Google Scholar
  11. 11.
    Dent J, Dodds WJ, Hogan WJ, Toouli J: Factors that influence induction of gastroesophageal reflux in normal human subjects. Dig Dis Sci 33:270–275, 1988Google Scholar
  12. 12.
    Mittal RK, McCallum RW: Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis. Gastroenterology 95:593–599, 1988Google Scholar
  13. 13.
    Corazziari E, Bontempo I, Anzini F, Torsoli A: Motor activity of the distal oesophagus and gastro-oesophageal reflux. Gut 25:7–13, 1984Google Scholar
  14. 14.
    Baldi F, Ferrarini F, Balestra R, Borioni D, Longanesi MM, Barbara L: Oesophageal motor events at the occurrence of acid reflux during endogenous acid exposure in healthy subjects and in patients with oesophagitis. Gut 26:336–341, 1985Google Scholar
  15. 15.
    Allen ML, DiMarino AJ, Robinson M: Gastroesophageal acid reflux during each type of transient lower esophageal sphincter relaxation: Just how appropriate are appropriate relaxations? Gastroenterology 104:A33, 1993 (abstract)Google Scholar
  16. 16.
    Allen ML, DiMarino AJ: Clinical significance of gastroesophageal reflux during normal and transient lower esophageal sphincter relaxation. Am J Gastroenterol 88:1481, 1993 (abstract)Google Scholar
  17. 17.
    Creamer B, Donoghue FE, Code CF: Pattern of esophageal motility in diffuse spasm. Gastroenterology 34:782–796, 1958Google Scholar
  18. 18.
    Craddock DR, Logan A, Walbaum PR: Diffuse esophageal spasm. Thorax 21:511–517, 1966Google Scholar
  19. 19.
    Gillies M, Nicks R, Skyring A: Clinical, manometric, and pathological studies in diffuse esophageal spasm. Br Med J 2:527–530, 1967Google Scholar
  20. 20.
    Orlando RC, Bozymski EM: Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. N Engl J Med 289:23–25, 1973Google Scholar
  21. 21.
    DiMarino AJ, Cohen S: Characteristics of lower esophageal sphincter function in symptomatic diffuse esophageal spasm. Gastroenterology 66:1–6, 1974Google Scholar
  22. 22.
    Mellow M: Symptomatic diffuse esophageal spasm: Manometric follow-up and response to cholinergic stimulation and cholinesterase inhibition. Gastroenterology 73:237–240, 1977Google Scholar
  23. 23.
    Swamy N: Esophageal spasm: Clinical and manometric response to nitroglycerine and long activity nitrates. Gastroenterology 72:23–27, 1977Google Scholar
  24. 24.
    Vantrappen G, Janssens J, Hellerman J, Coremans G: Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 76:450–457, 1979Google Scholar
  25. 25.
    Castell DO: Esophageal manometric studies: A perspective of their physiologic and clinical relevance. J Clin Gastroenterol 2:191–196, 1980Google Scholar
  26. 26.
    Davies HA, Kaye MD, Rhodes J, Dart AM, Henderson AH: Diagnosis of oesophageal spasm by ergometrine provocation. Gut 23:89–97, 1982Google Scholar
  27. 27.
    Patterson DR: Diffuse esophageal spasm in patients with undiagnosed chest pain. J Clin Gastroenterol 4:415–417, 1982Google Scholar
  28. 28.
    Allen ML, DiMarino AJ: Reflux-associated diffuse esophageal spasm. Am J Gastroenterol 87:1676, 1992 (letter)Google Scholar
  29. 29.
    Roth HP, Fleshler B: Diffuse esophageal spasm. Ann Intern Med 61:914–923, 1964Google Scholar
  30. 30.
    Traube M, McCallum RW: Primary oesophageal motility disorders: Current therapeutic concepts. Drugs 30:66–77, 1985Google Scholar
  31. 31.
    Dalton CB, Castell DO, Hewson EG, Wu WC, Richter JE: Diffuse esophageal spasm: A rare motility disorder not characterized by high-amplitude contractions. Dig Dis Sci 36:1025–1028, 1991Google Scholar
  32. 32.
    Campo S, Traube M: Manometric characteristics in idiopathic and reflux-associated esophageal spasm. Am J Gastroenterol 87:187–189, 1992Google Scholar
  33. 33.
    Traube M: Response to Drs. Allen and DiMarino. Am J Gastroenterol 87:1676–1677, 1992 (letter)Google Scholar

Copyright information

© Plenum Publishing Corporation 1996

Authors and Affiliations

  • Melvin L. Allen
    • 1
  • Anthony J. DiMarinoJr
    • 1
  1. 1.From the Division of Gastroenterology, Presbyterian Medical Center of PhiladelphiaUniversity of Pennsylvania School of MedicinePhiladelphia

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