(Spastic Pseudodivertikulose, Rosary or Korkenzieherösophagus)

The symptomatic diffuse esophageal spasm is part of a spectrum of motility disorders that are characterized by different nichtpropulsive contractions by octane contractions and by an increased pressure in the LES. Symptoms include chest pain and sometimes dysphagia. The diagnosis is made by a barium swallow or manometry. The therapy is difficult, it consists of nitrates, calcium channel blockers, injections of botulinum toxin and antireflux therapy.

The symptomatic diffuse esophageal spasm is part of a spectrum of motility disorders that are characterized by different nichtpropulsive contractions by octane contractions and by an increased pressure in the LES. Symptoms include chest pain and sometimes dysphagia. The diagnosis is made by a barium swallow or manometry. The therapy is difficult, it consists of nitrates, calcium channel blockers, injections of botulinum toxin and antireflux therapy.

(S. a. Overview Esophageal dysphagia). The symptomatic diffuse esophageal spasm is part of a spectrum of motility disorders that are characterized by different nichtpropulsive contractions by octane contractions and by an increased pressure in the LES. Symptoms include chest pain and sometimes dysphagia. The diagnosis is made by a barium swallow or manometry. The therapy is difficult, it consists of nitrates, calcium channel blockers, injections of botulinum toxin and antireflux therapy. The changes in the Ösophagusmotilität correlate poorly with the symptoms of patients, similar changes may cause different or no symptoms in different individuals. Moreover, neither symptoms nor abnormal contractions are definitely associated with histopathological changes in the esophagus. Symptoms and signs A diffuse esophageal typically causes substernal chest pain and dysphagia for liquid and solid food. The pain may wake the patient during sleep. Very cold drinks can worsen the pain. In the course of years, this disease can lead to achalasia. Esophageal spasm can cause intense pain without dysphagia. The pain is often described as substernal aching pain and can occur under load. He can not be distinguished from angina pectoris. Diagnosis Esophageal barium swallow may test for coronary ischemia Alternative diagnoses include coronary ischemia, if necessary by appropriate tests (eg. As ECG, cardiac markers, stress testing -see diagnosis of acute coronary syndromes) must be excluded. A reliable diagnosis of esophageal origin is difficult because the symptoms. The barium swallow may show a reduced progression of the bolus and uncoordinated simultaneous contractions or tertiary contractions. A severe spasm can radiologically resemble a diverticulum, but varies in size and location. Manometry of the esophagus gives the best representation of the spasm. At least 20% of the swallowing tests must (<4.5 s) have a short distal latency to be the manometric criteria for diffuse esophageal spasm meet. However, the spasms during the investigation must not occur. A Speiseröhrenszintigraphie and provocative tests with medication (z. B. edrophonium chloride 10 mg i.v.) have not proved to be helpful in diagnosis. Therapy calcium channel blocker injection with botulinum toxin therapy of esophageal spasm is difficult, controlled trials of treatment forms are missing. Anticholinergics, tricyclic antidepressants, nitroglycerin and long-acting nitrates have a limited effect. Calcium channel blocker, given orally (z. B. verapamil 80 mg 3 times a day, nifedipine 10 mg 3 times daily), may be useful, as injections of botulinum toxin type A into the lower oesophageal sphincter. Treatment with medication is usually successful, otherwise a surgical myotomy over the entire length of the esophagus was tried in refractory cases.

Health Life Media Team

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