Review of current diagnosis and management of diffuse esophageal spasm, nutcracker esophagus/spastic nutcracker and hypertensive lower esophageal sphincter

2013 ◽  
Vol 21 (6) ◽  
pp. 543-547 ◽  
Author(s):  
Stephen Burmeister
Keyword(s):  
Lower Esophageal Sphincter ◽  
Diffuse Esophageal Spasm ◽  
Nutcracker Esophagus ◽  
Diagnosis And Management ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Esophageal Spasm ◽  
Esophageal Sphincter

Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification

2021 ◽  
Vol 1 (3) ◽  
pp. 254-262
Author(s):  
Mario Costantini ◽  
Renato Salvador ◽  
Andrea Costantini
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Current Knowledge ◽  
Unexpected Finding ◽  
Diffuse Esophageal Spasm ◽  
Extreme Caution ◽  
Motility Disorders ◽  
Diagnosis And Management ◽  
Chicago Classification ◽  
Esophageal Spasm

Spastic esophageal motility disorders are represented, as per the Chicago classification 4.0, by diffuse esophageal spasm and hypercontractile esophagus. They are very rare and therefore poorly understood. The diagnosis is usually made by manometry in presence of dysphagia or chest pain, but often it is often an unexpected finding. In this paper, the authors review the current knowledge and possible treatments of these disorders, when needed. They underline that invasive treatments, as surgical myotomy or POEM, are rarely necessary and that the indications for them are based on low quality studies. Therefore, they should be used with extreme caution in treating spastic motility disorders other than achalasia.

The hypertensive lower esophageal sphincter

1989 ◽  
Vol 34 (7) ◽  
pp. 1063-1067 ◽  
Author(s):  
Nahum Freidin ◽  
Morris Traube ◽  
Ravinder K. Mittal ◽  
Richard W. McCallum
Keyword(s):  
Lower Esophageal Sphincter ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Esophageal Sphincter

scholarly journals Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

1991 ◽  
Vol 5 (2) ◽  
pp. 51-57 ◽  
Author(s):  
William G Paterson ◽  
Delia A Marciano-D’Amore ◽  
Ivan T Beck ◽  
Laurington R Da Costa
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Motility Disorder ◽  
Diffuse Esophageal Spasm ◽  
Esophageal Motility Disorder ◽  
Nutcracker Esophagus ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Acid Perfusion ◽  
Provocative Testing

In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test) and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg) was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40%) experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17%) experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

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