DIFFUSE ESOPHAGEAL SPASM
Intermittent dysphagia is caused by?
| A |
1,2 & 3 |
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| B |
2,3 & 4 |
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| C |
4 & 5 |
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| D |
3,4 & 5 |
Intermittent dysphagia is caused by?
| A |
1,2 & 3 |
|
| B |
2,3 & 4 |
|
| C |
4 & 5 |
|
| D |
3,4 & 5 |
| Intermittent dysphagia | Progressive dysphagia |
| Diffuse esophageal spasm Pharyngeal diverticulum Schatzki ring Esophagitis |
Carcinoma esophagus
Stricture Achalasia cardia |
Also know:
- Dysphagia more for solid than liquid implies mechanical obstruction (Ca esophagus, stricture, webs)
- Dysphagia equal for both solid and liquid from the very onset suggests motor disorder i.e achalasia and diffuse esophageal spasm.
Ref: Harrison 17/e, Page 239; CMDT 2005, Page 546.
Diffuse esophageal spasm is best diagnosed by:
| A |
Endoscopy |
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| B |
Manaometry |
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| C |
Barium swallow |
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| D |
CT |
Diffuse esophageal spasm is best diagnosed by:
| A |
Endoscopy |
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| B |
Manaometry |
|
| C |
Barium swallow |
|
| D |
CT |
Answer is B (Manometry)
Diffuse oesophageal spasm is a type of oesophageal motility disorder. Such Motility disorders are best diagnosed by Manometry studies
`Esophageal manometry is the key test for establishing the diagnosis of diffuse esophageal spasm’ – CSDT
`Esophageal manometry is the only test that distinguishes diffuse esophageal spasm from other primary esophageal motor disorders.
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Diffuse Esophageal spasm: |
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Diffuse Esophageal spasm is a poorly understood hypermotility disorder of the oesophagus |
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Presentation |
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– Symptoms are aggravated by emotional stress, exertion (or related to eating) |
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Diagnosis |
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Manometry is the key to establish the diagnosis |
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The diagnosis is usually made by an esophagogram (Barium swallow) and monometric study |
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Esophagogram Manometry |
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(Barium Swallow) |
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• Manometry is the key to establish the diagnosis (CSDT) |
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• Corkscrew esophagus is classical of Diffuse Correlation of subjective complains with evidence of spasm |
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esophageal spasm (seen in about 30% of cases) (induced by vagomimetic drug bethenechol) on manometric |
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(Radiological evidence of tertiary contractions) studies prvide convincing evidence-Sabiston |
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• Esophageal monometry is the only test that distinguishes |
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diffuse esophageal spasm from other primary esophageal motor disorders – CSDT |
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• An ambulatory motility record (ambulatory manometry) is |
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preferred over standard manometry as contractions are |
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intermittent and normal peristalsis is seen in between. |
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Ambulatory manometry is the single best investigation with a sensitivity of 90% and specificity of 100% |
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