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Diffuse oesophageal spasm (DES)

Overview

DES is characterised by uncoordinated, often very strong, and irregular oesophageal contractions. These spasms can result in substantial chest pain and dysphagia (difficulty swallowing).

The cause of DES is unclear, but the following may play a role in its occurrence:

  • Neuromuscular dysfunction:
    • Impaired inhibitory neurotransmission: Normally, the oesophagus uses excitatory as well as inhibitory neurotransmitters to regulate smooth muscle contraction. In DES, there may be reduced or absent inhibitory signals from the nerves that control digestion and related processes (enteric system), leading to simultaneous uncoordinated contractions of the oesophageal muscles.
    • Disrupted smooth muscle function: The smooth muscle in the oesophagus may respond abnormally to neural signals, causing spasms or contractions that are out of sync with normal peristalsis.
  • Gastroesophageal reflux disease (GERD)
  • Hypersensitivity to acid
  • Psychological stress
  • Oesophageal inflammation
  • Genetic factors
  • Ageing
  • Oesophageal structural abnormalities

  • Chest pain (which may mimic heart attack symptoms)
  • Dysphagia (difficulty swallowing)
  • Regurgitation (this is less common than in other oesophageal motility disorders)

  • Oesophageal manometry: This test is used to diagnose DES based on the measurement of uncoordinated contractions.
  • Barium swallow: A barium swallow may reveal a "corkscrew" pattern in the oesophagus.

  • Medications:
    • Calcium channel blockers or nitrates: These are used to relax the oesophageal smooth muscles and reduce the spasms.
    • Prokinetic agents and antidepressants: These are used for nerve modulation.
  • Botulinum toxin (Botox): In refractory (nonresponding) cases, Botox injections may be considered to reduce spasms by inhibiting the release of acetylcholine, which is known to induce smooth muscle contraction.
  • Surgery: This is used in severe cases.
    • Esophagectomy (removal of all or parts of the oesophagus)
    • Myotomy (cutting of muscles in the oesophagus)
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