Clinical Characteristics of Diffuse Esophageal Spasm

Choi, Kyoo Wan; Paik, Seung Woon; Rhee, Jong Chul; Kim, Jae Jun; Koh, Kwang Cheol; Rhee, Poong Lyul; Jeon, Seong Gook; Sohn, Chong Il

Abstract

BACKGROUND AND AIMS: Diffuse esophageal spasm (DES) was known to be a rare esophageal motility disorder and only few data related to the clinical and manometric characteristics were available in Korean patients. The aim of this study was to evaluate the clinical and manometric charactetistics of DES.
METHODS
Eleven patients, 4 males and 6 females, who underwent esophageal manometry ia Samsung Medical Center between February 1995 to June 1997 and met the criteria for DES, were selected. The mean age of the patients was 51.6 years (28-75 years). The clinical symptoms, gastroscopic findings, esophagographic findings, esophageal manometric findings and therapeutic response of the patients were retrospectively analyzed.
RESULTS
The chief complaints of the patients were chest pain (n=5), dysphagia (n=3), globus (n=1), acid regurgitation (n=1) and indigestion (n=1). The tertiary contractions on esophagography were found in 3 patients. The findings of esophageal manometry were repetitive contractions (>_3 peaks/wave) in 4 patients (36%), contractions of prolonged duration (>6 seconds) in 3 patients (27%), spontaneous contractions in 4 patients (36%), nontransmitted contractions in 7 patients (64%), high LES pressure (>_ 45 mmHg) in 1 patient (9%) and incomplete relaxation of LES in 1 patient (9%). High amplitude (>_180 mmHg) contraction was not found. The prevalence of simultaneous contractions was 42% (13-100%) and it was higher in patients with dysphagia (75%) than in patients with other symptoms (10-30%). There was symptomatic improvement in 3 out of 5 patients treated with caleium channel blockers and in 1 patient treated with nitrates.
CONCLUSIONS
The DES was manifestated with chest pain or dysphagia. The prevalence of simultaneous contractions was high in patients with dysphagia. High amplitude contraction was not found. There was symptomatic improvement in some patients teated with calcium channel blockers or nitrates.