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Review
. 2020 Mar 26;8(6):1026-1032.
doi: 10.12998/wjcc.v8.i6.1026.

Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry

Harika Gorti  1 , Salih Samo  2 , Nikrad Shahnavaz  2 , Emad Qayed  3
Affiliations
Review

Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry

Harika Gorti et al. World J Clin Cases. .

Abstract

Distal esophageal spasm (DES) is a rare major motility disorder in the Chicago classification of esophageal motility disorders (CC). DES is diagnosed by finding of ≥ 20% premature contractions, with normal lower esophageal sphincter (LES) relaxation on high-resolution manometry (HRM) in the latest version of CCv3.0. This feature differentiates it from achalasia type 3, which has an elevated LES relaxation pressure. Like other spastic esophageal disorders, DES has been linked to conditions such as gastroesophageal reflux disease, psychiatric conditions, and narcotic use. In addition to HRM, ancillary tests such as endoscopy and barium esophagram can provide supplemental information to differentiate DES from other conditions. Functional lumen imaging probe (FLIP), a new cutting-edge diagnostic tool, is able to recognize abnormal LES dysfunction that can be missed by HRM and can further guide LES targeted treatment when esophagogastric junction outflow obstruction is diagnosed on FLIP. Medical treatment in DES mostly targets symptomatic relief and often fails. Botulinum toxin injection during endoscopy may provide a temporary therapy that wears off over time. Myotomy through peroral endoscopic myotomy or via surgical Heller myotomy can provide long term relief in cases with persistent symptoms.

Keywords: Distal esophageal spasm; Esophageal motility; Esophagus; Functional lumenal imaging probe; High-resolution manometry; Spastic achalasia.

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Conflict of interest statement

Conflict-of-interest statement: Authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
Barium esophagogram in a patient with distal esophageal spasm showing corkscrew (or rosary beads) appearance of the esophagus, and delayed passage of contrast to the stomach. The corkscrew appearance results from tertiary, non-propulsive contractions of the esophagus circular muscles.
Figure 2
Figure 2
High-resolution manometry of normal swallow and a premature swallow in a patient with distal esophageal spasm. A: High-resolution manometry of normal swallow; B: High-resolution manometry of a premature swallow. CDP: Contractile deceleration point; DL: Distal latency; IRP: Integrated relaxation pressure.
Figure 3
Figure 3
A proposed algorithm for management of diffuse esophageal spasm. CCB: Calcium channel blocker; DES: Distal esophageal spasm; FLIP: Functional lumen imaging probe; HRM: High-resolution manometry; LES: Lower esophageal sphincter; PDE: Phosphodiesterase; POEM: Per oral endoscopic myotomy; PPI: Proton pump inhibitor.
See this image and copyright information in PMC

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