Diffuse Spasm - Disorders of the Esophagus

DIFFUSE SPASM

Diffuse spasm is a motor disorder of the esophagus. The cause is unknown, but stressful situations can produce contractions of the esophagus. It is more common in women and usually manifests in middle age.

Clinical Manifestations

Diffuse spasm is characterized by difficulty or pain on swallow-ing (dysphagia, odynophagia) and by chest pain similar to that of coronary artery spasm.

Assessment and Diagnostic Findings

Esophageal manometry, which measures the motility of the esophagus and the pressure within the esophagus, indicates thatsimultaneous contractions of the esophagus occur irregularly. Di-agnostic x-ray studies after ingestion of barium show separate areas of spasm.

Management

Conservative therapy includes administration of sedatives and long-acting nitrates to relieve pain. Calcium channel blockers have also been used to manage diffuse spasm. Small, frequent feedings and a soft diet are usually recommended to decrease the esophageal pressure and irritation that lead to spasm. Dilation performed by bougienage (use of progressively sized flexible dila-tors), pneumatic dilation, or esophagomyotomy may be necessary if the pain becomes intolerable.