Diffuse oesophageal spasm - Disorders of the oesophagus

Diffuse oesophageal spasm

Definition

A severe form of abnormal oesophageal mobility.

Aetiology/pathophysiology

There is a generalised abnormality of the oesophagus with resultant hypermotility leading to painful oesophageal spasms. The resting pressure and relaxation of the lower oesophageal sphincter is normal.

Clinical features

Pain is retrosternal and ranges from mild to severe colicky spasms that occur spontaneously or on swallowing.

Investigations

Barium swallow may show a corkscrew appearance due to contracted muscle (nutcracker oesophagus). Manometry can be used to identify the diseased segment and is required prior to surgery.

Management

Calcium channel blockers can reduce the amplitude of the contractions. Nitrates have also been used with some success. Surgical intervention with open or thoracoscopic myotomy is considered in refractory cases. The myotomy should extend the entire length of the involved segment of oesophagus and through the lower oesophageal sphincter. To prevent gastrooesophageal reflux a fundoplication should also be performed.