Relationship between diffuse esophageal spasm and lower esophageal sphincter dysfunction on barium studies and manometry in 14 patients

Anand Prabhakar, Marc S. Levine, Stephen Rubesin, Igor Laufer, David A Katzka

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE. We sought to reassess the function and clinical characteristics of the lower esophageal sphincter in a series of patients with radiographically defined diffuse esophageal spasm. MATERIALS AND METHODS. In reviewing records in the radiology database at our hospital, we identified 14 patients with diffuse esophageal spasm confirmed on barium studies who also underwent esophageal manometry. The radiographic findings were reviewed and correlated with the manometric findings. Medical records were also reviewed to determine the clinical presentation, treatment, and patient course. RESULTS. All 14 patients were symptomatic, presenting with dysphagia, chest pain, or both. All the barium studies revealed intermittently absent or weakened peristalsis, with non-peristaltic contractions that were moderate in six patients (43%) and marked in eight patients (57%) (contractions nearly obliterating the lumen in six and completely obliterating the lumen in two). Nine patients (64%) had impaired opening of the lower esophageal sphincter, manifested by beaklike narrowing of the distal esophagus, and five (36%) had normal opening of the lower esophageal sphincter. Manometry revealed abnormal peristalsis in all 14 patients, with repetitive simultaneous contractions in eight (57%) and lower esophageal sphincter dysfunction in 12 (86%). All eight patients with lower esophageal sphincter dysfunction or incomplete relaxation of the lower esophageal sphincter on barium studies or manometry who were treated with the Clostridium botulinum toxin or endoscopic balloon dilatation had a positive response. CONCLUSION. Our preliminary data show that diffuse esophageal spasm is characterized on barium studies by frequent lower esophageal sphincter dysfunction rather than a classic corkscrew appearance. Barium and manometric studies may have complementary roles in the evaluation of patients with diffuse esophageal spasm.

Original languageEnglish (US)
Pages (from-to)409-413
Number of pages5
JournalAmerican Journal of Roentgenology
Volume183
Issue number2
StatePublished - Aug 2004
Externally publishedYes

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Diffuse Esophageal Spasm
Lower Esophageal Sphincter
Manometry
Barium
Peristalsis
Botulinum Toxins
Deglutition Disorders
Chest Pain
Radiology
Esophagus
Medical Records
Dilatation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Relationship between diffuse esophageal spasm and lower esophageal sphincter dysfunction on barium studies and manometry in 14 patients. / Prabhakar, Anand; Levine, Marc S.; Rubesin, Stephen; Laufer, Igor; Katzka, David A.

In: American Journal of Roentgenology, Vol. 183, No. 2, 08.2004, p. 409-413.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. We sought to reassess the function and clinical characteristics of the lower esophageal sphincter in a series of patients with radiographically defined diffuse esophageal spasm. MATERIALS AND METHODS. In reviewing records in the radiology database at our hospital, we identified 14 patients with diffuse esophageal spasm confirmed on barium studies who also underwent esophageal manometry. The radiographic findings were reviewed and correlated with the manometric findings. Medical records were also reviewed to determine the clinical presentation, treatment, and patient course. RESULTS. All 14 patients were symptomatic, presenting with dysphagia, chest pain, or both. All the barium studies revealed intermittently absent or weakened peristalsis, with non-peristaltic contractions that were moderate in six patients (43{\%}) and marked in eight patients (57{\%}) (contractions nearly obliterating the lumen in six and completely obliterating the lumen in two). Nine patients (64{\%}) had impaired opening of the lower esophageal sphincter, manifested by beaklike narrowing of the distal esophagus, and five (36{\%}) had normal opening of the lower esophageal sphincter. Manometry revealed abnormal peristalsis in all 14 patients, with repetitive simultaneous contractions in eight (57{\%}) and lower esophageal sphincter dysfunction in 12 (86{\%}). All eight patients with lower esophageal sphincter dysfunction or incomplete relaxation of the lower esophageal sphincter on barium studies or manometry who were treated with the Clostridium botulinum toxin or endoscopic balloon dilatation had a positive response. CONCLUSION. Our preliminary data show that diffuse esophageal spasm is characterized on barium studies by frequent lower esophageal sphincter dysfunction rather than a classic corkscrew appearance. Barium and manometric studies may have complementary roles in the evaluation of patients with diffuse esophageal spasm.",
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