Diffuse Esophageal Spasm

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Abstract
Nine patients with diffuse esophageal spasm were studied. Attacks of dysphagia, substernal pain, and in one case, syncope appeared before age 35 in two patients and before 50 in 3 others. Radiographic and intraluminal pressure studies were performed in the nine patients with diffuse spasm and in 7 patients with tertiary contractions but no symptoms. There is no difference between the 2 groups in the average amplitude of the recorded contractions. The percent of esophageal contractile activity which is spastic in nature and the number of repetitive waves following the initial contractions are greater in the group with diffuse spasm, although the differences in this small series are not statistically significant. Repetitive waves, observed during the cineroentgenographic studies were frequently associated with ineffective transport of a barium bolus. Emptying is ineffective when the peaks of pressure did not pass sequentially down the esophagus. When the peaks of pressure are distally sequential emptying is effective even if there are tertiary contractions on x-ray or large spastic waves on the motility record. Pain is associated with a prolonged rather than a large contraction. Spastic contractions, although diminished in amplitude persisted following esophago-myotomy and were uneffected by repair of associated hiatal hernia.

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