Nursing experience of one patient with diffuse esophageal spasm undergoing peroral endoscopic myotomy / 中华护理杂志

This paper summarized nursing experience of one patient with diffuse esophageal spasm(DES) undergoing peroral endoscopic myotomy (POEM).Key points of nursing included:preoperative training of use of medical bedpan;respiratory functional exercises;postoperative management of body position,nursing of gastrointestinal decompression,management of refined diet and prevention and nursing of complications.The patient recovered well and no complication occurred.The patient was discharged on the eighth day after surgery.

Symptomatic Improvement of Diffuse Esophageal Spasm after Botulinum Toxin Injection / 대한소화기학회지

Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up.

Manometric and symptomatic spectrum of motor dysphagia in a tertiary referral center in northern India.

Background We studied the spectrum of motor dysphagia in a northern Indian tertiary referral center. Methods In this retrospective study, consecutive patients with motor dysphagia referred to the Gastrointestinal Pathophysiology and Motility Laboratory from 2002 to 2007 were evaluated clinically and with eight-channel water-perfusion manometry. Causes of dysphagia were diagnosed using standard criteria. Results Of 250 patients (age 41.3 [15.0] years, 146 men), 193 (77%) had achalasia cardia (AC) and 57 (23%) had other causes (11, 4.4%: diffuse esophageal spasm [DES]; 9, 3.6%: hypertensive lower esophageal sphincter [Hy LES]); manometry was normal in 37 patients. Twenty-seven patients (14%) had vigorous AC. Duration of dysphagia at presentation was longer in those with AC and Hy LES than in normal manometry (NM) (21 months [1–180] vs. 6 [1–360], p = 0.000; 24 months [7–48] vs. 6 [1–360], p = 0.015). Regurgitation and bolus obstruction were more frequent in those with AC than in NM (89/154, 57.79% vs. 3/27, 11.11%, p = 0.000001). Heartburn was less frequent in patients with AC than in others (AC: 4/146, 2.73% vs. normal: 4/27, 14.8% [p = 0.02] and others: 3/15, 20% [p = 0.018]). Chest pain was reported by 74/135 (54.8%) classic and 12/19 (63.2%) vigorous AC (p = NS). Patients with NM had lower LES pressure than those with classic AC, Hy LES and vigorous AC (p < 0.0001 in each case). Patients with DES had lower LES pressure than in classic AC, Hy LES and vigorous AC (p = 0.043, p < 0.0001, and p = 0.002, respectively). Patients with classic AC had lower LES pressure than in Hy LES and vigorous AC (p = 0.024, p = 0.001, respectively). Conclusion Classic AC was the commonest cause of motor dysphagia in our center. AC was associated with higher LES pressure, longer duration of dysphagia, frequent regurgitation and bolus obstruction.

Evolução motora incomum na doença do refluxo gastroesofágico / Unusual motor disorder on GERD

INTRODUÇÃO: Demonstra-se que os distúrbios motores esofágicos como o espasmo esofageano difuso podem progredir para acalásia. Também é conhecida a associação entre a doença do refluxo gastroesofágico e alguns destes distúrbios. RELATO DO CASO: Paciente com queixa de dor torácica, disfagia e perda de peso há dois meses. A primeira endoscopia digestiva alta sugeriu apenas dismotilidade esofágica. Posteriormente, realizou manometria esofágica que evidenciou alterações em corpo compatíveis com espasmo esofageano difuso, sem alterações no esfíncter esofageano inferior. Na oportunidade iniciou o tratamento com pantoprazol e nifedipina que se estendeu por oito meses; no entanto manteve-se sintomática. Após suspender medicação por 10 dias, realizou pH-metria esofageana prolongada constatando-se refluxo gastroesofágico patológico combinado e refluxo proximal, sendo submetida ao tratamento com esomeprazol e mantida a nifedipina. Após dois meses, com a persistência dos sintomas, realizou-se nova endoscopia que evidenciou estase alimentar e manometria esofágica com aperistalse completa de corpo. Neste momento, optou-se por cardiomiotomia a Heller com fundoplicatura laparoscópica. A endoscopia do terceiro mês do pós-operatório evidenciou fundoplicatura bem ajustada ao aparelho. No seguimento a médio prazo ela permanece assintomática. CONCLUSÃO: Existe correlação entre os distúrbios motores esofágicos e a doença do refluxo gastroesofágico, e o tratamento cirúrgico para corrigir a acalásia e o refluxo gastroesofágico ao mesmo tempo, pode ser indicado em casos selecionados.

BACKGROUND: It is shown that esophageal motor disorders, such as diffuse esophageal spasm, may progress to achalasia. It is also known a link between gastroesophageal reflux disease and some of these motor disorders. CASE REPORT: Patient complaining of chest pain, dysphagia and weight loss for two months. The first endoscopy suggested only motility disorders. Esophageal manometry was done and showed changes in body compatible with diffuse esophageal spasm, without changes in lower esophageal sphincter. Treatment with pantoprazole and nifedipine for eight months was done, but the patient remained symptomatic. After stopping medication for 10 days, an esophageal pH-metry was realized and showed gastro-esophageal reflux. She was submitted to treatment with esomeprazole and nifedipine. After two months, with persistence of the symptoms, a new endoscopy showed food stasis, and esophageal manometry body esophageal aperistalsis. At this point, surgical treatment (Heller cardiomyotomy with fundoplication) was done. Endoscopy of the third postoperative month showed fundoplication well adjusted to the endoscope. In follow-up, patient remained asymptomatic. CONCLUSION: There is a correlation between esophageal motor disorders and gastroesophageal reflux disease, and surgical treatment to correct achalasia and gastroesophageal reflux at the same time, may be indicated in selected cases.

Factors involved in the Transition from Achalasia to Nutcracker Esophagus or Diffuse Esophageal Spasm after Intrasphincteric Injection of Botulinum Toxin / 대한소화관운동학회지

BACKGROUND/AIMS: To evaluate the factors which are related to the transition from achalasia to diffuse esophageal spasm (DES) or nutcracker esophagus (NE) after botulinum toxin injection to lower esophageal sphincter (LES). METHODS: This study included the 23 patients with achalasia who received an intrasphincteric injection of botulinum toxin. Stational esophageal manometry, 24-hour ambulatory esophageal manometry with pH monitoring, barium esophagogram and endoscopic ultrasonography were performed before and after treatment. We analyzed the parameters from these studies between the cases that transformed to DES or NE within a week and the cases that do not transit. RESULT: Five patients (21.7%) transformed to DES (1) or NE (4) within a week. There were significant differences in contraction amplitude of esophageal body (median, 31 mmHg vs 23 mmHg, p < 0.05) and maximal diameter of esophageal body (median, 2.6 cm vs 4.4 cm, p < 0.05) between these five patients and the remaining patients. There were no significant differences in sex, LES pressure and thickness of muscle layer between two groups. CONCLUSION: Factors involved in transition to NE or DES after botulinum toxin injection to LES of achalasia appears as high amplitude contractions in body of esophagus and less dilation of esophageal body.

Changes of Esophageal Motor Function Depending on the Different Types of the Bolus / 대한소화관운동학회지

BACKGROUND/AIMS: It is suggested that diffuse esophageal spasm (DES), nutcracker esophagus (NUT), and hypertensive lower esophageal sphincter (HLES) could be re-classified together as a spastic esophageal motility disorder of similar clinical backgrounds. However, there were no studies to evaluate the pathophysiological characteristics of these motor abnormalities. The aim of the study was to evaluate the changes of esophageal motor function depending on the different types of the bolus (water vs semi-solid bolus). METHODS: Twenty-one healthy subjects and 42 subjects with primary esophageal motility disorders (4 DES, 12 NUT, 5 HLES, 12 nonspecific esophageal motility disorders, 9 normal) underwent a perfusion manometry with a low compliance pneumo-hydraulic capillary infusion system. Consecutively, each patient had 10 swallows of water and 10 swallows of Jello, 5 ml each. RESULTS: In the healthy controls, the Jello swallow showed an increased amplitude and duration of distal esophageal contractions, and the velocity of peristalsis was decreased (p < 0.05). Among all patients diagnosed by manometry with the water swallow, 2 cases diagnosed with HLES (40%) and 4 with NUT (33%) were changed to a diagnoses of DES after the Jello swallow. Moreover, HLES was found in 1 patient with DES (25%) and in 6 patients with NUT (50%). CONCLUSIONS: Semi-solid bolus swallows increase the contractile force of the esophagus more than water swallows. A conventional manometric diagnosis could be changed to a different spastic motility disorder of the esophagus after a semi-solid bolus swallow. It is suggested that DES, NUT, and HLES can be considered as a spectrum of spastic esophageal motility disorders sharing a similar pathophysiology.

A Case of a Diffuse Esophageal Spasm Diagnosis by Ambulatory 24 hour Manometry / 대한소화관운동학회지

Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of 10 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific findings on the laboratory based manometry, but DES was diagnosed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry should always be performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature.