Abstract
Of 1200 patients referred to the esophageal laboratory at Guy's Hospital for investigation of suspected esophageal motility disorders, 61 (5.1%) were diagnosed as diffuse esophageal spasm. Twenty of these patients whose symptoms were severe did not respond to conservative treatment and were treated by balloon dilatation. Results were good in 14 and poor in six patients, which included one esophageal perforation. Diffuse esophageal spasm was diagnosed where more than 30% nonperistaltic activity was demonstrated by manometry. Lower esophageal sphincter pressure and relaxation were normal in all cases except one. Gastroesophageal reflux was present in four of five poor responders who were examined by 24-h ambulatory pH monitoring, and in only one of 10 good responders. Three of the six patients in whom balloon dilatation was successful proceeded to full-length myotomy, with relief of symptoms in two. The indications for, and results of, balloon dilatation in this condition are discussed, and a new radiological sign is described.
Similar content being viewed by others
References
Richter JE, Bradley LA, Castell DO. Esophageal chest pain: current controversies in pathogenesis, diagnosis and therapy.Ann Intern Med 1989;110:66–78
Katz PO, Dalton BD, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagia.Ann Intern Med 1987;106:593–597
Bennet JR. Treatment of achalasia: a review.J R Soc Med 1980;73:649–654
Fellows IW, Ogilvie AL, Atkinson M. Pneumatic dilatation in achalasia.Gut 1983;24:1020–1023
Winters C, Artnak EJ, Benjamin SB, Castel DO. Esophageal bouginage in symptomatic patients with the nutcracker esophagus.JAMA 1984;252:363–366
Ebert EC, Ouyang A, Wright SH, Cohen S, Lipshutz WH. Pneumatic dilatation in patients with symptomatic diffuse esophageal spasm and lower esophageal sphincter dysfunction.Dig Dis Sci 1983;28:481–485
Ellis FH Jr, Olsen AM, Schlegel JF, Coad CF. Surgical treatment of esophageal hypermotility disturbances.JAMA 1964;188:862–866
De Meester TR. Prolonged oesophageal pH monitoring. In: Read NW ed.Gastrointestinal motility—which test. Wrightson Biometrical Publishing Ltd., Peters Field, 1989:41–52
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Irving, J.D., Owen, W.J., Linsell, J. et al. Management of diffuse esophageal spasm with balloon dilatation. Gastrointest Radiol 17, 189–192 (1992). https://doi.org/10.1007/BF01888544
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01888544