Skurcze przełyku – Patofizjologia i mechanizm

Skurcze przełyku
Patofizjologia i mechanizm

Skurcze przełyku, w tym rozlany skurcz przełyku (DES) i przełyk dziadkowy, są zaburzeniami motoryki charakteryzującymi się nieskoordynowanymi lub nadmiernie silnymi skurczami mięśni przełyku, co prowadzi do dysfagii i bólu zamostkowego. Patogeneza DES wiąże się z dysfunkcją neuronów hamujących w dystalnej części przełyku, zwłaszcza zmniejszeniem stężenia tlenku azotu (NO) – kluczowego neuroprzekaźnika hamującego – oraz nadmiernym uwalnianiem acetylocholiny. Diagnostyka opiera się na manometrii wysokiej rozdzielczości (HRM), gdzie DES rozpoznaje się przy co najmniej 20% połknięć z krótką latencją skurczów dystalnych, a przełyk dziadkowy definiuje się jako skurcze o średniej sile przekraczającej 180 mmHg lub DCI > 8000 mmHg·cm/s u 20% skurczów. Skurcze przełyku mogą być wywołane przez czynniki takie jak długotrwałe stosowanie opioidów, które hamują wydzielanie NO i peptydu wazoaktywnego jelitowego, prowadząc do charakterystycznych dla DES jednoczesnych skurczów o wysokiej amplitudzie.

Patogeneza skurczy przełyku

Skurcze przełyku to zaburzenie motoryki przełyku charakteryzujące się nieprawidłowymi, nieskoordynowanymi lub gwałtownymi skurczami mięśni przełyku, które utrudniają prawidłowy pasaż pokarmu do żołądka. Etiologia skurczy przełyku pozostaje w znacznym stopniu niewyjaśniona, jednak współczesne badania dostarczają coraz więcej informacji na temat mechanizmów leżących u podstaw tej patologii.¹²³

Zaburzenia równowagi neuroprzekaźników

Kluczowym mechanizmem w patogenezie skurczy przełyku wydaje się być zaburzenie równowagi między szlakami hamującymi i pobudzającymi w splocie mięśniowym przełyku. U podstaw tego zjawiska leży prawdopodobnie dysfunkcja neuronów hamujących w dystalnej części przełyku.⁴⁵ Szczególną uwagę zwraca się na rolę tlenku azotu (NO), który jest głównym neuroprzekaźnikiem hamującym w splocie mięśniowym. Zmniejszenie stężenia tlenku azotu lub zaburzenia w jego syntezie mogą prowadzić do przedwczesnych i gwałtownie rozprzestrzeniających się skurczów, charakterystycznych dla rozlanego skurczu przełyku (DES).⁶⁷

Jednocześnie obserwuje się zwiększone uwalnianie acetylocholiny, która działa jako neuroprzekaźnik pobudzający. Ta nadmierna aktywność cholinergiczna, przy jednoczesnym niedoborze czynników hamujących, prowadzi do nieskoordynowanych skurczów mięśni przełyku.⁸⁹ Badania wykazały, że sztuczne hamowanie syntezy tlenku azotu może wywoływać objawy podobne do tych obserwowanych w rozlanym skurczu przełyku.¹⁰

Mechanizm skurczów rozlanych

W rozlanym skurczu przełyku (DES) dochodzi do wadliwego rozprzestrzeniania się fal perystaltycznych. Charakteryzuje się on przedwczesnymi skurczami dystalnymi mięśni gładkich przełyku, prowadzącymi do dysfagii i bólu zamostkowego niesercowego pochodzenia.¹¹ W przeciwieństwie do prawidłowej perystaltyki, gdzie skurcze mięśni są skoordynowane i postępują w kierunku żołądka, w DES kilka segmentów przełyku kurczy się jednocześnie i niezależnie od siebie, co uniemożliwia prawidłowe przesuwanie się kęsa pokarmowego.¹²¹³

Badania z wykorzystaniem manometrii wysokiej rozdzielczości (HRM) wykazały, że w DES występuje zmniejszenie latencji skurczowej dystalnej, co oznacza, że skurcze pojawiają się przedwcześnie po połknięciu. Zgodnie z kryteriami diagnostycznymi, DES rozpoznaje się, gdy co najmniej 20% połknięć powoduje skurcze dystalne przełyku o krótkiej latencji.¹⁴¹⁵

Rola odruchów nerwowych

Skurcze przełyku mogą być związane z nieprawidłowym funkcjonowaniem nerwów kontrolujących mięśnie wykorzystywane podczas połykania.¹⁶ Ten mechanizm jest szczególnie istotny w kontekście zaburzeń koordynacji perystaltyki przełyku. Prawidłowy proces połykania wymaga precyzyjnej koordynacji między różnymi częściami przełyku, a zaburzenia w przekazywaniu sygnałów nerwowych mogą prowadzić do nieskoordynowanych skurczów.¹⁷

Wiele mechanizmów inicjacji i kontroli aktywności motorycznej przełyku zlokalizowanych jest na różnych poziomach ośrodkowego układu nerwowego, a także obwodowo w obrębie nerwów i mięśni śródściennych. Ta redundancja ma implikacje dla funkcjonowania mechanizmów rezerwowych, gdy pierwotny mechanizm kontrolny jest uszkodzony lub dysfunkcyjny.¹⁸

Związek z chorobą refluksową

Istnieją dowody na związek między skurczami przełyku a chorobą refluksową przełyku (GERD). Długotrwały refluks żołądkowo-przełykowy może prowadzić do skurczów, szczególnie gdy dochodzi do zwężenia przełyku.¹⁹²⁰ Kwas żołądkowy może uszkadzać nerwy w przełyku, co przyczynia się do zaburzeń nerwowo-mięśniowych i nieprawidłowych skurczów.²¹

Związek między DES a GERD pozostaje przedmiotem debaty naukowej. Niektórzy badacze uważają, że refluks może być czynnikiem wyzwalającym lub zaostrzającym skurcze przełyku, podczas gdy inni podkreślają ich niezależny charakter.²²²³

Czynniki wyzwalające

Chociaż dokładna przyczyna skurczów przełyku pozostaje nieznana, zidentyfikowano pewne czynniki wyzwalające, które mogą prowokować epizody skurczów. Należą do nich:²⁴²⁵

Spożywanie bardzo gorących lub bardzo zimnych pokarmów i płynów
Niedostateczne przeżucie pokarmu przed połknięciem
Alergie lub nietolerancje pokarmowe
Długotrwałe stosowanie opioidów (badania wykazują zwiększone ryzyko skurczów przełyku u osób przyjmujących opioidy przez okres dłuższy niż trzy miesiące)

²⁶²⁷²⁸

Wpływ opioidów na rozwój skurczów przełyku

Nowsze badania wskazują na związek między długotrwałym stosowaniem opioidów a rozwojem skurczów przełyku. Opioidy hamują pobudliwość neuronalną, która prowadzi do wydzielania hamujących neuroprzekaźników, takich jak tlenek azotu i peptyd wazoaktywny jelitowy.²⁹ To zmniejsza gradient latencji w dystalnej części przełyku i prowadzi do jednoczesnych skurczów o wysokiej amplitudzie, charakterystycznych dla DES.³⁰ Istotne jest, że skurcze przełyku związane ze stosowaniem opioidów często ustępują po zaprzestaniu ich przyjmowania.³¹

Typy kliniczne skurczów przełyku

Skurcze przełyku można podzielić na dwa główne typy, które stanowią odrębne jednostki:³²³³

Rozlany skurcz przełyku (DES)

Rozlany skurcz przełyku (znany również jako dystalny skurcz przełyku) charakteryzuje się nieskoordynowanymi skurczami, które często występują wraz z regurgitacją treści pokarmowej. W DES fale perystaltyczne nie rozprzestrzeniają się prawidłowo – kilka segmentów przełyku kurczy się jednocześnie, co uniemożliwia prawidłowe przesuwanie się kęsa pokarmowego i prowadzi do trudności w połykaniu.³⁴³⁵

Diagnostyka DES opiera się głównie na manometrii przełyku, która wykazuje, że co najmniej 20% połknięć powoduje skurcze o krótkiej latencji dystalnej. To oznacza, że skurcze pojawiają się przedwcześnie, zanim powinny w normalnym przebiegu perystaltyki.³⁶³⁷

Przełyk dziadkowy (hypercontractile esophagus)

Przełyk dziadkowy (znany również jako przełyk hiperkinetyczny lub przełyk korkociągowy) charakteryzuje się prawidłowo skoordynowanymi, ale nadmiernie silnymi skurczami przełyku. Skurcze postępują w sposób zorganizowany, popychając pokarm w dół przełyku, ale ich amplituda przekracza normę o co najmniej 2 odchylenia standardowe.³⁸³⁹

Według kryteriów diagnostycznych, przełyk dziadkowy rozpoznaje się, gdy średnia siła skurczów dystalnej części przełyku przekracza 180 mmHg, a skurcze przełyku są pod innymi względami prawidłowe. W nowszej definicji, wykorzystującej manometrię wysokiej rozdzielczości, przełyk dziadkowy (określany także jako przełyk młotowy) występuje, gdy 20% skurczów przełyku ma dystalny indeks skurczowy (DCI) przekraczający 8000 mm Hg cm/s.⁴⁰⁴¹

Powiązanie z innymi zaburzeniami motoryki przełyku

Istnieje wyraźne powiązanie między rozlanym skurczem przełyku a innymi zaburzeniami motoryki przełyku, w szczególności achalazją. Uważa się, że DES i spastyczna achalazja (achalazja typu 3) mają wspólny szlak patofizjologiczny.⁴²⁴³

Badania wykazały, że utrata neuronów hamujących jest wspólnym mechanizmem dla tych zaburzeń. W achalazji obserwuje się degenerację splotu mięśniowego z infiltracją limfocytów T, co koreluje odwrotnie z liczbą zachowanych zwojów. Podobnie w DES, utrata neuronów hamujących prowadzi do nieprawidłowych skurczów przełyku.⁴⁴⁴⁵

Interesujące jest to, że u niektórych pacjentów DES może z czasem przekształcić się w achalazję, co dodatkowo wspiera teorię o ich wspólnym podłożu patofizjologicznym. Badania sugerują, że takie przejście następuje u około 3-5% pacjentów z DES.⁴⁶

Rola badań diagnostycznych w ocenie mechanizmów skurczów przełyku

Zrozumienie mechanizmów leżących u podstaw skurczów przełyku było możliwe dzięki rozwojowi nowoczesnych technik diagnostycznych, w szczególności manometrii wysokiej rozdzielczości (HRM) i topografii ciśnień przełyku (EPT).⁴⁷ Te metody znacząco poprawiły możliwość diagnozy skurczów przełyku, umożliwiając dokładną ocenę czasu, siły i koordynacji skurczów.⁴⁸

HRM pomaga odróżnić prawdziwy skurcz przełyku od gwałtownego wzrostu ciśnienia śródbolowego spowodowanego ogniskową dysmotoryką lub obstrukcją. Zastosowanie tego rozróżnienia sprawia, że diagnoza DES staje się rzadka.⁴⁹

Nowszym narzędziem diagnostycznym jest funkcjonalna sonda obrazowania światła (FLIP), która jest coraz częściej wykorzystywana jako dodatkowe narzędzie diagnostyczne w ocenie zaburzeń przełyku. FLIP może identyfikować obstrukcję połączenia przełykowo-żołądkowego (EGJOO) w przypadku zaburzeń spastycznych z prawidłowym zintegrowanym ciśnieniem relaksacji w HRM, co rodzi podejrzenie, że zaburzenia spastyczne, takie jak przełyk młotowy i DES, są często związane z EGJOO, które nie jest wykrywane przez HRM.⁵⁰

Hipotezy dotyczące patogenezy

Chociaż dokładna etiologia skurczów przełyku pozostaje nieznana, istnieje kilka hipotez wyjaśniających mechanizm inicjujący to zaburzenie:⁵¹⁵²

Nieskoordynowane sygnały mózgowe – zaburzenia w przekazywaniu sygnałów z mózgu do nerwów kontrolujących przełyk mogą prowadzić do nieprawidłowych skurczów
Pierwotne zaburzenia nerwów ruchowych – dysfunkcja nerwów kontrolujących motorykę przełyku
Zwiększone uwalnianie acetylocholiny z powodu nieznanego mechanizmu
Choroba refluksowa przełyku – długotrwały refluks żołądkowo-przełykowy może prowadzić do skurczów, szczególnie gdy dochodzi do zwężenia przełyku
Niedokrwienie ściany przełyku – przedłużone skurcze mięśni podłużnych przełyku mogą powodować niedokrwienie ściany przełyku, co czasowo koreluje z bólem przełyku/zgagą

⁵³⁵⁴⁵⁵

Rola stresu i zaburzeń psychicznych

Interesującym aspektem patogenezy skurczów przełyku jest ich związek ze stresem i zaburzeniami psychicznymi. Badania wykazały, że pacjenci z zaburzeniami lękowymi lub depresją mogą być bardziej podatni na występowanie skurczów przełyku.⁵⁶⁵⁷

Stres aktywuje reakcję organizmu na zagrożenie, powodując wiele zmian fizjologicznych, psychologicznych i emocjonalnych, które przygotowują organizm do natychmiastowego działania w sytuacji awaryjnej. Każda z tych zmian może powodować drżenie mięśni, drgania i skurcze, w tym skurcze przełyku u niektórych osób, ponieważ przełyk jest mięśniem.⁵⁸

U niektórych osób skurcze przełyku mogą być spowodowane ostrym stresem, takim jak ostry lęk. Ponadto skurcze przełyku są częstym objawem nadmiernej stymulacji (przewlekłego stresu) u niektórych osób.⁵⁹

Zaburzenia demielinizacyjne a skurcze przełyku

Badania wykazały związek między stwardnieniem rozsianym (SM), które jest chorobą zapalną charakteryzującą się demielinizacją głównie ośrodkowego układu nerwowego, a skurczami przełyku. Pacjenci z SM mają większe szanse na rozwój achalazji lub DES w porównaniu z pacjentami bez SM.⁶⁰

Sugeruje to, że ci pacjenci mają cięższy fenotyp choroby w odniesieniu do stopnia degradacji neuronalnej i demielinizacji powodującej dysfunkcję autonomiczną. Uważa się, że mechanizm leżący u podstaw związku między achalazją a SM jest napędzany przez podobne czynniki środowiskowe, takie jak infekcje wirusowe, oraz autoimmunizację limfocytów T skierowaną przeciwko neuronom przed- i pozazwojowym.⁶¹⁶²

Czynniki genetyczne

Istnieją doniesienia o rodzinach z achalazją i skurczem przełyku, co wspiera hipotezę, że cechy genetyczne mogą odgrywać rolę w patogenezie DES, a także wskazuje na związek między tymi dwoma zaburzeniami. Jednak dziedziczenie genetyczne nie zostało w pełni ustalone.⁶³

Inne mechanizmy

Badania wskazują również na inne potencjalne mechanizmy prowadzące do skurczów przełyku, w tym:⁶⁴⁶⁵

Nadwrażliwość przełyku – odnosi się do dysfunkcji czuciowej, w której pacjenci odczuwają dyskomfort lub ból przy progach znacznie niższych niż te doświadczane przez zdrowe osoby
Centralna sensytyzacja – badania sugerują, że percepcja bólu w bólu zamostkowym pochodzenia przełykowego może być spowodowana centralną sensytyzacją
Uszkodzenie rdzenia kręgowego – może być powiązane z przełykiem dziadkowym
Przepuklina rozworu przełykowego – może mieć związek z przełykiem dziadkowym
Problemy z nerwem błędnym – mogą być powiązane z przełykiem dziadkowym

⁶⁶⁶⁷

Badania naukowe nad mechanizmami skurczów przełyku

Badania naukowe nad mechanizmami skurczów przełyku koncentrują się głównie na zaburzeniach równowagi między szlakami hamującymi i pobudzającymi w splocie mięśniowym przełyku. Szczególną uwagę zwraca się na rolę tlenku azotu jako kluczowego neuroprzekaźnika hamującego.⁶⁸⁶⁹

Wykazano, że sztuczne zahamowanie syntezy tlenku azotu poprzez podanie zmiatacza NO (rekombinowanej hemoglobiny) powoduje nieprawidłowości w czasie perystaltyki przełyku, wywołując jednoczesne skurcze na całej długości mięśni gładkich i zmniejszenie latencji skurczowej. Wspiera to hipotezę, że szlak hamujący odgrywa główną rolę w rozwoju DES i innych zaburzeń spastycznych motoryki.⁷⁰

Badania nad związkiem między DES a chorobą refluksową przełyku (GERD) pozostają przedmiotem debaty. Podobnie, związek DES z zaburzeniami psychicznymi wymaga dalszych badań.⁷¹

Coraz więcej dowodów wskazuje na związek między stosowaniem opioidów a zaburzeniami spastycznymi przełyku, w tym DES. Opioidy hamują pobudliwość neuronalną, co prowadzi do zmniejszenia wydzielania hamujących neuroprzekaźników, takich jak tlenek azotu i peptyd wazoaktywny jelitowy. To zmniejsza gradient latencji w dystalnej części przełyku i prowadzi do jednoczesnych skurczów o wysokiej amplitudzie, charakterystycznych dla DES.⁷²

Z powodu nieznanej etiologii DES, większość leków farmakologicznych ma na celu leczenie objawów, z ograniczonymi wskaźnikami powodzenia. Przyszłe badania wyjaśniające tę jednostkę chorobową mogą pomóc w lepszym zrozumieniu patofizjologii DES, prowadząc do bardziej skutecznych opcji leczenia.⁷³

Nowe kierunki badań

Nowe badania koncentrują się na lepszym zrozumieniu roli tlenku azotu w regulacji perystaltyki przełyku oraz na opracowaniu bardziej skutecznych metod leczenia skurczów przełyku. Coraz większą uwagę zwraca się również na badanie motoryki przełyku przy pomocy nowoczesnych technik, takich jak manometria wysokiej rozdzielczości (HRM) i funkcjonalna sonda obrazowania światła (FLIP).⁷⁴⁷⁵

Mimo że nowa metodologia jest przydatna do oceny funkcji motorycznej przełyku, potrzebne są dalsze badania w celu doprecyzowania kryteriów diagnostycznych i rozwiązania niepewnych kwestii.⁷⁶ Przyszłe badania wyjaśniające patofizjologię DES mogą doprowadzić do opracowania bardziej skutecznych strategii leczenia, które złagodzą objawy i poprawią jakość życia osób dotkniętych tym zaburzeniem.⁷⁷

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Materiały źródłowe

#1 Diffuse Esophageal Spasm – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK541106/
Diffuse esophageal spasm (DES) is a rare esophageal motility disorder characterized by simultaneous, uncoordinated, or rapidly propagated contractions that are of normal amplitude and accompanied by dysphagia. […] The etiology of diffuse esophageal spasm is unknown. There are various theories proposed. […] There is a disruption of coordination in peristalsis, which is probably due to an imbalance between the inhibitory and excitatory postganglionic pathways. […] The diffuse esophageal spasm occurs due to defective propagation of peristaltic waves through the esophageal wall. Several segments of the esophagus contract independently of each other simultaneously, thus causing improper propagation of the food bolus in DES. […] Increased release of acetylcholine is thought to play a major role in diffuse esophageal spasm, but what causes the release of the neurotransmitter is not known.
#2 Esophageal Spasm: Background, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/174975-overview
Broadly, esophageal spasm can be divided into two major variants that are distinct entities: (1) diffuse esophageal spasm and (2) hypertensive peristalsis. […] The etiology of esophageal spasm is unknown. Increased release of acetylcholine appears to be a factor (sensitive to cholinergic stimulation), but the triggering event is not known. Other theories include gastric reflux or a primary nerve or motor disorder. Body mass index (BMI) and total cholesterol may be highly predictive factors for esophageal body contractility, whereas BMI and glucose may be predictive factors for lower esophageal sphincter contractile function. […] A number of mechanisms for the initiation and control of esophageal motor activity are located at different levels within the central nervous system, as well as peripherally within the intramural nerves and muscles. This redundancy has implications for the operation of reserve mechanisms when a primary control mechanism is damaged or dysfunctional.
#3 Esophageal spasms – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/esophageal-spasms/symptoms-causes/syc-20372250
Esophageal spasms are painful contractions in the muscular tube connecting the mouth and stomach, called the esophagus. […] It’s not clear what causes esophageal spasms. However, they appear to be related to abnormal functioning of nerves that control the muscles used when swallowing. […] A healthy esophagus moves food into the stomach through a series of coordinated muscle contractions. Esophageal spasms make it difficult for the muscles in the walls of the lower esophagus to coordinate. This makes it harder for the muscles to move food to the stomach. […] There are two types of esophageal spasms distal esophageal spasm and hypercontractile esophagus, also known as nutcracker esophagus.
#4 Distal Esophageal Spasm: An Updated Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10404380/
Distal esophageal spasm is characterized by premature contractions of the distal esophageal smooth muscle leading to non-obstructive dysphagia and non-cardiac chest pain. […] DES involves abnormal coordination within the smooth muscles of the esophagus, likely stemming from an imbalance between the nitrogenic inhibitory and cholinergic excitatory pathways. […] A major point of focus has been nitric oxide (NO) due to its role in the inhibitory pathway of the myenteric plexus. […] It has been hypothesized that a reduction in this interval could potentially lead to premature and rapidly propagating contractions in DES. […] Gastroesophageal reflux disease (GERD) might also be related to DES. […] Spastic achalasia is another disorder believed to be pathophysiologically related to DES.
#5 What Are Esophageal Spasms: Everything That You Should Know – Princeton Gastroenterology Associates
https://princetongi.com/what-are-esophageal-spasms-everything-that-you-should-know/
Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] The use of phosphodiesterase inhibitors such as sildenafil can relax your esophagus, thus relieving pain. In addition, sildenafil will also relax the lower esophageal sphincter, alleviating difficulty in swallowing. […] Your doctor can also administer botulinum toxins, which reduce acetylcholine secretion, resulting in temporary symptom relief.
#6 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
Distal esophageal spasm (DES) is thought to result from an imbalance between the nitrogenic inhibitory pathway and the cholinergic excitatory pathway in the myenteric plexus. […] The interval of deglutitive inhibition was defined as contractile latency; and it was hypothesized that a decrease in this interval would result in spontaneous contractions or spasms. […] It has also been shown that subjects receiving a nitric oxide (NO) scavenger (recombinant hemoglobin) had abnormalities in the timing of esophageal peristalsis causing simultaneous contractions along the length of smooth muscles and a decrease in contractile latency. […] This supported the hypothesis that the inhibitory pathway plays a major role in the development of DES and other spastic motility disorders. […] DES can be seen in association with other conditions.
#7 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Given the impaired LES relaxation seen in achalasia, the inflammatory process is thought to be selective for inhibitory neurons crucial for normalizing resting smooth muscle tone. […] Several studies investigating the role of nitric oxide (NO) have shown that artificial inhibition of NO synthase mimic physiological findings seen in achalasia. […] DES also shows similar findings of impaired inhibitory neurons leading to inappropriate esophageal contractions, with several studies showing absence of deglutitive inhibition and restoration of function with NO production. […] Both achalasia and DES share a common proposed mechanism of impaired inhibitory innervation of the esophagus. […] We believe that the mechanism behind the relationship between achalasia and MS is driven by similar environmental triggers such as viral infections, and T cell autoimmunity directed at pre and post-ganglionic neurons. Thus, susceptibility to one increases the risk for the other via a shared underlying mechanism. […] Although the etiology of DES is incompletely understood with multiple theories proposed, most experts agree that impaired inhibitory innervation by malfunction of endogenous NO synthesis is the predominant mechanism.
#8 Diffuse Esophageal Spasm – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK541106/
Diffuse esophageal spasm (DES) is a rare esophageal motility disorder characterized by simultaneous, uncoordinated, or rapidly propagated contractions that are of normal amplitude and accompanied by dysphagia. […] The etiology of diffuse esophageal spasm is unknown. There are various theories proposed. […] There is a disruption of coordination in peristalsis, which is probably due to an imbalance between the inhibitory and excitatory postganglionic pathways. […] The diffuse esophageal spasm occurs due to defective propagation of peristaltic waves through the esophageal wall. Several segments of the esophagus contract independently of each other simultaneously, thus causing improper propagation of the food bolus in DES. […] Increased release of acetylcholine is thought to play a major role in diffuse esophageal spasm, but what causes the release of the neurotransmitter is not known.
#9 Esophageal spasm – Wikipedia
https://en.wikipedia.org/wiki/Esophageal_spasm
Esophageal spasm is a disorder of motility of the esophagus. […] There are two types of esophageal spasm: Diffuse or distal esophageal spasm (DES), where there is uncoordinated esophageal contractions; Nutcracker esophagus (NE) also known as hypertensive peristalsis, where the contractions are coordinated but with an excessive amplitude. […] Both conditions are linked to gastroesophageal reflux disease (GERD). […] When the coordinated muscle contraction are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. […] The increased release of acetylcholine may also be a factor, but the triggering event is not known. […] The diagnosis is generally confirmed by esophageal manometry. […] DES is present when more than a fifth of swallows results in distal esophageal contractions.
#10 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Given the impaired LES relaxation seen in achalasia, the inflammatory process is thought to be selective for inhibitory neurons crucial for normalizing resting smooth muscle tone. […] Several studies investigating the role of nitric oxide (NO) have shown that artificial inhibition of NO synthase mimic physiological findings seen in achalasia. […] DES also shows similar findings of impaired inhibitory neurons leading to inappropriate esophageal contractions, with several studies showing absence of deglutitive inhibition and restoration of function with NO production. […] Both achalasia and DES share a common proposed mechanism of impaired inhibitory innervation of the esophagus. […] We believe that the mechanism behind the relationship between achalasia and MS is driven by similar environmental triggers such as viral infections, and T cell autoimmunity directed at pre and post-ganglionic neurons. Thus, susceptibility to one increases the risk for the other via a shared underlying mechanism. […] Although the etiology of DES is incompletely understood with multiple theories proposed, most experts agree that impaired inhibitory innervation by malfunction of endogenous NO synthesis is the predominant mechanism.
#11 Distal Esophageal Spasm: An Updated Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10404380/
Distal esophageal spasm is characterized by premature contractions of the distal esophageal smooth muscle leading to non-obstructive dysphagia and non-cardiac chest pain. […] DES involves abnormal coordination within the smooth muscles of the esophagus, likely stemming from an imbalance between the nitrogenic inhibitory and cholinergic excitatory pathways. […] A major point of focus has been nitric oxide (NO) due to its role in the inhibitory pathway of the myenteric plexus. […] It has been hypothesized that a reduction in this interval could potentially lead to premature and rapidly propagating contractions in DES. […] Gastroesophageal reflux disease (GERD) might also be related to DES. […] Spastic achalasia is another disorder believed to be pathophysiologically related to DES.
#12 What Are Esophageal Spasms: Everything That You Should Know – Princeton Gastroenterology Associates
https://princetongi.com/what-are-esophageal-spasms-everything-that-you-should-know/
Chest pain and dysphagia (difficulty in swallowing) account for a reasonable percentage of hospital consultations. In some patients, these occur due to a spasm of the esophagus, a muscular tube that moves food from the mouth to the stomach. […] An esophageal spasm is an involuntary painful muscular contraction of the esophagus, a tube connecting the mouth and the stomach. Esophageal spasms are perceived as sudden severe chest pain lasting minutes to hours. […] Abnormal muscular contraction of the esophagus can occur in several ways. However, the resulting spasms can be broadly classified into two; nutcracker esophagus and diffuse esophageal spasms. […] Diffuse esophageal spasms occur due to defective propagation of peristaltic waves. In diffuse esophageal spasms, there are uncoordinated contractions of several esophageal segments. These contractions result in poor propagation of the food and drinks, leading to difficulty in swallowing and regurgitation.
#13 What Are Esophageal Spasms? – Gastroenterology Medical Associates
https://gastrospecialistsnj.com/what-are-esophageal-spasms/
The diffuse esophageal spasm occurs due to defective propagation of peristaltic waves. In diffuse esophageal spasms, there are uncoordinated contractions of several esophageal segments. These contractions result in poor propagation of the food and drinks, leading to difficulty in swallowing and regurgitation. […] Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] Some of the symptoms that suggest esophageal spasms are: Chest Pain, The pain of esophageal spasms is felt at the center of the chest.
#14 Distal Esophageal Spasm – Gastrointestinal Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/distal-esophageal-spasm
Esophageal manometry provides the most specific description of the spasms. At least 20% of test swallows must have a short distal latency. […] Esophageal spasms are often difficult to treat, and controlled studies of treatment methods are lacking. Oral calcium channel blockers may be useful. Anticholinergics, tricyclic antidepressants, nitroglycerin, and long-acting nitrates may also be tried but generally have limited success. […] Rarely, a trial of injecting botulinum toxin type A into the esophagus and/or lower esophageal sphincter is done. […] If medical management fails, a myotomy may be considered. A surgical or peroral endoscopic extended myotomy of the esophagus has been tried in severe cases.
#15 Esophageal spasm – Wikipedia
https://en.wikipedia.org/wiki/Esophageal_spasm
Esophageal spasm is a disorder of motility of the esophagus. […] There are two types of esophageal spasm: Diffuse or distal esophageal spasm (DES), where there is uncoordinated esophageal contractions; Nutcracker esophagus (NE) also known as hypertensive peristalsis, where the contractions are coordinated but with an excessive amplitude. […] Both conditions are linked to gastroesophageal reflux disease (GERD). […] When the coordinated muscle contraction are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. […] The increased release of acetylcholine may also be a factor, but the triggering event is not known. […] The diagnosis is generally confirmed by esophageal manometry. […] DES is present when more than a fifth of swallows results in distal esophageal contractions.
#16 Esophageal spasms – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/esophageal-spasms/symptoms-causes/syc-20372250
Esophageal spasms are painful contractions in the muscular tube connecting the mouth and stomach, called the esophagus. […] It’s not clear what causes esophageal spasms. However, they appear to be related to abnormal functioning of nerves that control the muscles used when swallowing. […] A healthy esophagus moves food into the stomach through a series of coordinated muscle contractions. Esophageal spasms make it difficult for the muscles in the walls of the lower esophagus to coordinate. This makes it harder for the muscles to move food to the stomach. […] There are two types of esophageal spasms distal esophageal spasm and hypercontractile esophagus, also known as nutcracker esophagus.
#17 Esophageal spasm – WikEM
https://wikem.org/wiki/Esophageal_spasm
Strong spasms of the musculature of the esophagus that can last minutes to hours and mimic the chest pain of angina […] Unclear what causes esophageal spasm. Possibly related to food intolerance. […] Esophageal spasm is a diagnosis of exclusion. Work-up should focus on ruling out more serious etiologies. […] Diagnosis of exclusion […] Upper gastrointestinal endoscopy with esophageal biopsies obtained to rule out other causes […] Followed by esophageal manometry.
#18 Esophageal Spasm: Background, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/174975-overview
Broadly, esophageal spasm can be divided into two major variants that are distinct entities: (1) diffuse esophageal spasm and (2) hypertensive peristalsis. […] The etiology of esophageal spasm is unknown. Increased release of acetylcholine appears to be a factor (sensitive to cholinergic stimulation), but the triggering event is not known. Other theories include gastric reflux or a primary nerve or motor disorder. Body mass index (BMI) and total cholesterol may be highly predictive factors for esophageal body contractility, whereas BMI and glucose may be predictive factors for lower esophageal sphincter contractile function. […] A number of mechanisms for the initiation and control of esophageal motor activity are located at different levels within the central nervous system, as well as peripherally within the intramural nerves and muscles. This redundancy has implications for the operation of reserve mechanisms when a primary control mechanism is damaged or dysfunctional.
#19 What Are Esophageal Spasms: Everything That You Should Know – Princeton Gastroenterology Associates
https://princetongi.com/what-are-esophageal-spasms-everything-that-you-should-know/
Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] The use of phosphodiesterase inhibitors such as sildenafil can relax your esophagus, thus relieving pain. In addition, sildenafil will also relax the lower esophageal sphincter, alleviating difficulty in swallowing. […] Your doctor can also administer botulinum toxins, which reduce acetylcholine secretion, resulting in temporary symptom relief.
#20 Esophageal Spasms: Symptoms, Causes, Treatment & Medication
https://my.clevelandclinic.org/health/diseases/15575-esophageal-spasms
Esophageal spasms happen when abnormal muscle contractions in your esophagus make it harder for food and liquids to reach your stomach. […] If you have esophageal spasms, these contractions dont work correctly. Unusually powerful or ineffective muscle contractions in your esophagus can make it difficult for food or liquid to move through your esophagus. […] Medical experts dont know the exact cause. But some believe spasms happen because of faulty nerves that control how your esophagus muscles work. […] In some instances, the faulty nerves may relate to excess acid in your esophagus. Many people with esophageal spasms also have chronic acid reflux (GERD). With this condition, stomach acid flows back up to your esophagus. Its possible that the acid damages nerves in your esophagus. […] Recent research suggests that people who use opioids for three months or longer are more likely to develop esophageal spasms.
#21 Esophageal Spasms: Symptoms, Causes, Treatment & Medication
https://my.clevelandclinic.org/health/diseases/15575-esophageal-spasms
Esophageal spasms happen when abnormal muscle contractions in your esophagus make it harder for food and liquids to reach your stomach. […] If you have esophageal spasms, these contractions dont work correctly. Unusually powerful or ineffective muscle contractions in your esophagus can make it difficult for food or liquid to move through your esophagus. […] Medical experts dont know the exact cause. But some believe spasms happen because of faulty nerves that control how your esophagus muscles work. […] In some instances, the faulty nerves may relate to excess acid in your esophagus. Many people with esophageal spasms also have chronic acid reflux (GERD). With this condition, stomach acid flows back up to your esophagus. Its possible that the acid damages nerves in your esophagus. […] Recent research suggests that people who use opioids for three months or longer are more likely to develop esophageal spasms.
#22 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
The relationship between DES and gastroesophageal reflux disease (GERD) is an area of continued debate. […] DES has also been linked to psychiatric conditions. […] Spastic esophageal disorders including DES are encountered more frequently in the setting of narcotics use. […] Opiates inhibit the neuronal excitability that leads to secretion of inhibitory neurotransmitters like NO and vasoactive intestinal peptide. […] This decreases the latency gradient in the distal esophagus, and results in simultaneous high-amplitude contraction (DES); and failure of LES to relax. […] DES and spastic achalasia (achalasia type 3) appear to share a common pathophysiologic pathway. […] The phenomenon of pseudo-relaxation may result from esophageal shortening during swallowing, and the actual LES to move upward along the catheter, leading the distal pressure sensor to measure the intragastric pressure rather than the actual LES pressure.
#23 Esophageal spasm – Wikipedia
https://en.wikipedia.org/wiki/Esophageal_spasm
Esophageal spasm is a disorder of motility of the esophagus. […] There are two types of esophageal spasm: Diffuse or distal esophageal spasm (DES), where there is uncoordinated esophageal contractions; Nutcracker esophagus (NE) also known as hypertensive peristalsis, where the contractions are coordinated but with an excessive amplitude. […] Both conditions are linked to gastroesophageal reflux disease (GERD). […] When the coordinated muscle contraction are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. […] The increased release of acetylcholine may also be a factor, but the triggering event is not known. […] The diagnosis is generally confirmed by esophageal manometry. […] DES is present when more than a fifth of swallows results in distal esophageal contractions.
#24 Esophageal Spasms | Loma Linda University Health
https://lluh.org/conditions/esophageal-spasms
When the muscular tube that connects your mouth to your stomach (the esophagus) tightens or contracts abnormally, it is known as spasm. Esophageal spasms are not very common. […] Although the cause of esophageal spasms isnt clear, these spasms may be related to abnormal functioning of the nerves that control the muscles you use to swallow. […] Consuming very hot or very cold foods or drinks, or foods that are not chewed enough before swallowing may trigger a spasm. […] Sometimes, symptoms that may suggest esophageal spasm are the result of another condition such as gastroesophageal reflux disease (GERD) or achalasia. […] If medication, lifestyle changes and home remedies dont sufficiently reduce or eliminate esophageal spasms, myotomy surgery may be recommended. In this procedure, the muscle at the lower end of the esophagus is cut to weaken esophageal contractions.
#25 Esophageal Spasm | The Children’s Hospital at Montefiore
https://www.cham.org/health-library/article?id=ut1638spec
Esophageal spasm means that contractions of the esophagus are irregular, uncoordinated, and sometimes powerful. […] The cause of esophageal spasm is unknown. Many doctors believe it results from a disruption of the nerve activity that coordinates the swallowing action of the esophagus. […] In some people, very hot or very cold foods may trigger an episode.
#26 Esophageal Spasms | Loma Linda University Health
https://lluh.org/conditions/esophageal-spasms
When the muscular tube that connects your mouth to your stomach (the esophagus) tightens or contracts abnormally, it is known as spasm. Esophageal spasms are not very common. […] Although the cause of esophageal spasms isnt clear, these spasms may be related to abnormal functioning of the nerves that control the muscles you use to swallow. […] Consuming very hot or very cold foods or drinks, or foods that are not chewed enough before swallowing may trigger a spasm. […] Sometimes, symptoms that may suggest esophageal spasm are the result of another condition such as gastroesophageal reflux disease (GERD) or achalasia. […] If medication, lifestyle changes and home remedies dont sufficiently reduce or eliminate esophageal spasms, myotomy surgery may be recommended. In this procedure, the muscle at the lower end of the esophagus is cut to weaken esophageal contractions.
#27 Esophageal Spasms: Symptoms, Causes, Treatment & Medication
https://my.clevelandclinic.org/health/diseases/15575-esophageal-spasms
Esophageal spasms happen when abnormal muscle contractions in your esophagus make it harder for food and liquids to reach your stomach. […] If you have esophageal spasms, these contractions dont work correctly. Unusually powerful or ineffective muscle contractions in your esophagus can make it difficult for food or liquid to move through your esophagus. […] Medical experts dont know the exact cause. But some believe spasms happen because of faulty nerves that control how your esophagus muscles work. […] In some instances, the faulty nerves may relate to excess acid in your esophagus. Many people with esophageal spasms also have chronic acid reflux (GERD). With this condition, stomach acid flows back up to your esophagus. Its possible that the acid damages nerves in your esophagus. […] Recent research suggests that people who use opioids for three months or longer are more likely to develop esophageal spasms.
#28 Diffuse esophageal spasm – Wikipedia
https://en.wikipedia.org/wiki/Diffuse_esophageal_spasm
Diffuse esophageal spasm (DES), also known as distal esophageal spasm, is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation. […] In many cases, the cause of DES remains unknown. […] The causes of diffuse esophageal spasm is unclear. It is thought, however, that many cases are caused by uncontrolled brain signals running to nerve endings. […] Food allergies or intolerances may also be a cause in which spasms may be triggered within hours or days from the offending foods.
#29 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
The relationship between DES and gastroesophageal reflux disease (GERD) is an area of continued debate. […] DES has also been linked to psychiatric conditions. […] Spastic esophageal disorders including DES are encountered more frequently in the setting of narcotics use. […] Opiates inhibit the neuronal excitability that leads to secretion of inhibitory neurotransmitters like NO and vasoactive intestinal peptide. […] This decreases the latency gradient in the distal esophagus, and results in simultaneous high-amplitude contraction (DES); and failure of LES to relax. […] DES and spastic achalasia (achalasia type 3) appear to share a common pathophysiologic pathway. […] The phenomenon of pseudo-relaxation may result from esophageal shortening during swallowing, and the actual LES to move upward along the catheter, leading the distal pressure sensor to measure the intragastric pressure rather than the actual LES pressure.
#30 Esophageal Spasms: Symptoms, Causes, Treatment & Medication
https://my.clevelandclinic.org/health/diseases/15575-esophageal-spasms
Esophageal spasms happen when abnormal muscle contractions in your esophagus make it harder for food and liquids to reach your stomach. […] If you have esophageal spasms, these contractions dont work correctly. Unusually powerful or ineffective muscle contractions in your esophagus can make it difficult for food or liquid to move through your esophagus. […] Medical experts dont know the exact cause. But some believe spasms happen because of faulty nerves that control how your esophagus muscles work. […] In some instances, the faulty nerves may relate to excess acid in your esophagus. Many people with esophageal spasms also have chronic acid reflux (GERD). With this condition, stomach acid flows back up to your esophagus. Its possible that the acid damages nerves in your esophagus. […] Recent research suggests that people who use opioids for three months or longer are more likely to develop esophageal spasms.
#31 Esophageal Spasms: Symptoms, Causes, Treatment & Medication
https://my.clevelandclinic.org/health/diseases/15575-esophageal-spasms
Esophageal spasm treatments focus on relaxing your esophageal muscles to relieve your symptoms. […] Your healthcare provider may recommend any of the following to treat esophageal spasms: […] Taking calcium channel blockers (blood pressure medicine) before eating helps many people swallow more easily. Taking nitrates can help relieve chest pain. Tricyclic antidepressants can target the faulty esophageal nerves, relieving pain. […] Botox injections temporarily paralyze your esophagus muscles, stopping spasms. […] During a myotomy, a provider makes an incision along your lower esophagus muscle. This incision stops the muscle from working entirely, which stops abnormal contractions. […] Esophageal spasms related to opioid use often resolve after you stop taking them.
#32 Esophageal Spasm: Background, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/174975-overview
Broadly, esophageal spasm can be divided into two major variants that are distinct entities: (1) diffuse esophageal spasm and (2) hypertensive peristalsis. […] The etiology of esophageal spasm is unknown. Increased release of acetylcholine appears to be a factor (sensitive to cholinergic stimulation), but the triggering event is not known. Other theories include gastric reflux or a primary nerve or motor disorder. Body mass index (BMI) and total cholesterol may be highly predictive factors for esophageal body contractility, whereas BMI and glucose may be predictive factors for lower esophageal sphincter contractile function. […] A number of mechanisms for the initiation and control of esophageal motor activity are located at different levels within the central nervous system, as well as peripherally within the intramural nerves and muscles. This redundancy has implications for the operation of reserve mechanisms when a primary control mechanism is damaged or dysfunctional.
#33 Esophageal spasms – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/esophageal-spasms/symptoms-causes/syc-20372250
Esophageal spasms are painful contractions in the muscular tube connecting the mouth and stomach, called the esophagus. […] It’s not clear what causes esophageal spasms. However, they appear to be related to abnormal functioning of nerves that control the muscles used when swallowing. […] A healthy esophagus moves food into the stomach through a series of coordinated muscle contractions. Esophageal spasms make it difficult for the muscles in the walls of the lower esophagus to coordinate. This makes it harder for the muscles to move food to the stomach. […] There are two types of esophageal spasms distal esophageal spasm and hypercontractile esophagus, also known as nutcracker esophagus.
#34 Esophageal Spasm: Causes, Symptoms, Treatments, & Diagnosis
https://www.webmd.com/digestive-disorders/what-is-esophageal-spasm
An esophageal spasm is the sudden, abnormal squeezing of the food pipe (esophagus) — the tube that carries food from your mouth to your stomach. […] Doctors are not sure what causes esophageal spasms, but it is known that they are a type of motility disorder. That means theres a problem with how the muscles in the food pipe squeeze together (contract) to move contents through the rest of the gastrointestinal (GI) system. Nerve signals from the brain tell the muscles in your esophagus to contract when you swallow something. Faulty nerve signaling may play a role in whether or not you develop this condition. […] There are two main types of esophagus spasms: Distal esophageal spasm (DES). These are uncoordinated spasms that often happen along with regurgitation. That means food and liquids come back up after you swallow them.
#35 What Are Esophageal Spasms? – Gastroenterology Medical Associates
https://gastrospecialistsnj.com/what-are-esophageal-spasms/
The diffuse esophageal spasm occurs due to defective propagation of peristaltic waves. In diffuse esophageal spasms, there are uncoordinated contractions of several esophageal segments. These contractions result in poor propagation of the food and drinks, leading to difficulty in swallowing and regurgitation. […] Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] Some of the symptoms that suggest esophageal spasms are: Chest Pain, The pain of esophageal spasms is felt at the center of the chest.
#36 Distal Esophageal Spasm – Gastrointestinal Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/distal-esophageal-spasm
Esophageal manometry provides the most specific description of the spasms. At least 20% of test swallows must have a short distal latency. […] Esophageal spasms are often difficult to treat, and controlled studies of treatment methods are lacking. Oral calcium channel blockers may be useful. Anticholinergics, tricyclic antidepressants, nitroglycerin, and long-acting nitrates may also be tried but generally have limited success. […] Rarely, a trial of injecting botulinum toxin type A into the esophagus and/or lower esophageal sphincter is done. […] If medical management fails, a myotomy may be considered. A surgical or peroral endoscopic extended myotomy of the esophagus has been tried in severe cases.
#37 Esophageal spasm – Wikipedia
https://en.wikipedia.org/wiki/Esophageal_spasm
Esophageal spasm is a disorder of motility of the esophagus. […] There are two types of esophageal spasm: Diffuse or distal esophageal spasm (DES), where there is uncoordinated esophageal contractions; Nutcracker esophagus (NE) also known as hypertensive peristalsis, where the contractions are coordinated but with an excessive amplitude. […] Both conditions are linked to gastroesophageal reflux disease (GERD). […] When the coordinated muscle contraction are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. […] The increased release of acetylcholine may also be a factor, but the triggering event is not known. […] The diagnosis is generally confirmed by esophageal manometry. […] DES is present when more than a fifth of swallows results in distal esophageal contractions.
#38 Esophageal Spasm: Background, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/174975-overview
Simplistically, diffuse esophageal spasms occur when the propagative waves do not progress correctly. Usually, several segments of the esophagus contract simultaneously, preventing the propagation of the food bolus. […] Nutcracker and jackhammer esophagus occur when the amplitude of the contractions exceed 2 standard deviations from normal. The contractions proceed in an organized manner, propelling food down the esophagus.
#39 Esophageal Spasm: Causes, Symptoms, Treatments, & Diagnosis
https://www.webmd.com/digestive-disorders/what-is-esophageal-spasm
Nutcracker or jackhammer esophagus. A twisted, or corkscrew-shaped, esophagus is often involved in powerful spasms. Regurgitation is not common with this type. […] Manometry. This is the only test that can confirm esophageal spasms. During this procedure, the doctor inserts a thin tube into your esophagus. Sensors on the tube measure pressure in the esophagus and reveal how well the muscles relax when you swallow. […] The goal of taking medicine is to relax the smooth muscle of the esophagus. One of the first recommendations may be to take peppermint oil or lozenges. Peppermint is a natural smooth muscle relaxant. If this doesn’t work, you may be asked to try a calcium channel blocker, often also given for heart issues, or a tricyclic antidepressant. […] Botulinum injections into the esophagus. This treatment relaxes the muscles of the esophagus. Its considered a helpful treatment for people with spasms. But the relief is temporary. Youll need repeated injections every few months. […] The only permanent cure for esophageal spasms is a surgical procedure called myotomy. The surgeon cuts the thick muscle in the lower part of the esophagus. This is only recommended in severe cases when medications and injections dont work.
#40 Esophageal spasm – Wikipedia
https://en.wikipedia.org/wiki/Esophageal_spasm
NE is present if the average strength of the contractions of the distal esophagus is greater than 180 mmHg but the contraction of the esophagus is otherwise normal. […] Since esophageal spasms are often associated with other disorders, management in these cases involve attempts to correct the underlying problem. […] If medical therapy fails either botulinum toxin injection or surgical myotomy may be tried in distal esophageal spasms.
#41 Hypercontractile (Nutcracker) Esophagus: Symptoms, Causes, and More
https://www.healthline.com/health/nutcracker-esophagus
Hypercontractile esophagus is a motility disorder in which there is abnormal movement and function of the esophagus. […] Hypercontractile esophagus occurs when 20% of your esophageal contractions have a distal contractile integral (DCI) of more than 8000 mm Hg cm/s. DCI calculates the force, length, and duration of esophageal contractions. […] The exact cause of hypercontractile esophagus is unknown. […] A 2022 review found that spinal injury, hiatal hernia, and vagus nerve problems may also have a link with hypercontractile esophagus. […] Hypercontractile esophagus is diagnosed using high-resolution manometry. […] However, research on treating hypercontractile esophagus is limited, and more research is needed to establish the best treatment. […] The exact cause of esophageal spasms is unknown. […] Some ways to quickly calm an esophageal spasm include taking nitroglycerin or calcium channel blockers.
#42 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
The relationship between DES and gastroesophageal reflux disease (GERD) is an area of continued debate. […] DES has also been linked to psychiatric conditions. […] Spastic esophageal disorders including DES are encountered more frequently in the setting of narcotics use. […] Opiates inhibit the neuronal excitability that leads to secretion of inhibitory neurotransmitters like NO and vasoactive intestinal peptide. […] This decreases the latency gradient in the distal esophagus, and results in simultaneous high-amplitude contraction (DES); and failure of LES to relax. […] DES and spastic achalasia (achalasia type 3) appear to share a common pathophysiologic pathway. […] The phenomenon of pseudo-relaxation may result from esophageal shortening during swallowing, and the actual LES to move upward along the catheter, leading the distal pressure sensor to measure the intragastric pressure rather than the actual LES pressure.
#43 Distal Esophageal Spasm: An Updated Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10404380/
Distal esophageal spasm is characterized by premature contractions of the distal esophageal smooth muscle leading to non-obstructive dysphagia and non-cardiac chest pain. […] DES involves abnormal coordination within the smooth muscles of the esophagus, likely stemming from an imbalance between the nitrogenic inhibitory and cholinergic excitatory pathways. […] A major point of focus has been nitric oxide (NO) due to its role in the inhibitory pathway of the myenteric plexus. […] It has been hypothesized that a reduction in this interval could potentially lead to premature and rapidly propagating contractions in DES. […] Gastroesophageal reflux disease (GERD) might also be related to DES. […] Spastic achalasia is another disorder believed to be pathophysiologically related to DES.
#44 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Multiple sclerosis (MS) is an inflammatory disease characterized by the demyelination of primarily the central nervous system. […] Mechanisms involving dysfunction of the pre- and post-ganglionic nerve fibers of the myenteric plexus have been proposed. […] Patients with MS have higher odds of developing achalasia or DES compared to patients without MS. […] This suggests that these patients have a more severe disease phenotype in regards to the extent of neuronal degradation and demyelination causing the autonomic dysfunction. […] Degeneration of the myenteric plexus is a well-known histopathological finding in achalasia; the degree of T cell infiltration, which is thought to be the cause of esophageal inflammation and fibrosis, is inversely correlated with the number of preserved ganglia.
#45 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Given the impaired LES relaxation seen in achalasia, the inflammatory process is thought to be selective for inhibitory neurons crucial for normalizing resting smooth muscle tone. […] Several studies investigating the role of nitric oxide (NO) have shown that artificial inhibition of NO synthase mimic physiological findings seen in achalasia. […] DES also shows similar findings of impaired inhibitory neurons leading to inappropriate esophageal contractions, with several studies showing absence of deglutitive inhibition and restoration of function with NO production. […] Both achalasia and DES share a common proposed mechanism of impaired inhibitory innervation of the esophagus. […] We believe that the mechanism behind the relationship between achalasia and MS is driven by similar environmental triggers such as viral infections, and T cell autoimmunity directed at pre and post-ganglionic neurons. Thus, susceptibility to one increases the risk for the other via a shared underlying mechanism. […] Although the etiology of DES is incompletely understood with multiple theories proposed, most experts agree that impaired inhibitory innervation by malfunction of endogenous NO synthesis is the predominant mechanism.
#46 A Case of Symptomatic Diffuse Esophageal Spasm During Multiple Rapid Swallowing Test on High-Resolution Manometry
https://www.jnmjournal.org/journal/view.html?uid=297&vmd=Full
Recently, the development of high-resolution manometry (HRM) and topographical displays has yielded new perspectives and insights into esophageal motor functions. HRM helps to differentiate true esophageal spasm from rapid elevation of the intra-bolus pressure due to focal dysmotility or obstruction. Applying this distinction makes the diagnosis of DES very rare. […] […] Several studies suggest that the motility disorders such as DES, nutcracker esophagus and achalasia share a common pathophysiologic mechanism, which involves the alteration in nitric oxide synthesis/degradation or loss of nitric oxide containing inhibitory neurons in the lower esophageal sphincter (LES). The loss of intramural inhibitory neurons leads to the loss of normal peristalsis and inability of the LES to relax properly during swallowing. DES is associated with incomplete LES relaxation, which is likely in a variant case of achalasia. The fact that the transition from DES to achalasia has been documented and is believed to occur in 3% to 5% of patients supports this observation. […] […] Although we do not know the specific mechanism through which an increase of the quantity of water induces symptoms, increment in the quantity of swallowing water may stimulate secondary peristalsis in esophagus more strongly and esophageal spasm could be provoked more easily.
#47 Diffuse Esophageal Spasm – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK541106/
Other hypothesis link diffuse esophageal spasm to reflux, elevated BMI, hyperlipidemia, and hyperglycemia. […] The classic presentation is a patient with episodic chest pain and intermittent dysphagia. […] The introduction of newer techniques like high-resolution manometry (HRM) and esophageal pressure topography (EPT) has significantly enhanced the ability to diagnose DES.
#48 Distal Esophageal Spasm: An Updated Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10404380/
Distal esophageal spasm is characterized by premature contractions of the distal esophageal smooth muscle leading to non-obstructive dysphagia and non-cardiac chest pain. […] DES involves abnormal coordination within the smooth muscles of the esophagus, likely stemming from an imbalance between the nitrogenic inhibitory and cholinergic excitatory pathways. […] A major point of focus has been nitric oxide (NO) due to its role in the inhibitory pathway of the myenteric plexus. […] It has been hypothesized that a reduction in this interval could potentially lead to premature and rapidly propagating contractions in DES. […] Gastroesophageal reflux disease (GERD) might also be related to DES. […] Spastic achalasia is another disorder believed to be pathophysiologically related to DES.
#49 A Case of Symptomatic Diffuse Esophageal Spasm During Multiple Rapid Swallowing Test on High-Resolution Manometry
https://www.jnmjournal.org/journal/view.html?uid=297&vmd=Full
Recently, the development of high-resolution manometry (HRM) and topographical displays has yielded new perspectives and insights into esophageal motor functions. HRM helps to differentiate true esophageal spasm from rapid elevation of the intra-bolus pressure due to focal dysmotility or obstruction. Applying this distinction makes the diagnosis of DES very rare. […] […] Several studies suggest that the motility disorders such as DES, nutcracker esophagus and achalasia share a common pathophysiologic mechanism, which involves the alteration in nitric oxide synthesis/degradation or loss of nitric oxide containing inhibitory neurons in the lower esophageal sphincter (LES). The loss of intramural inhibitory neurons leads to the loss of normal peristalsis and inability of the LES to relax properly during swallowing. DES is associated with incomplete LES relaxation, which is likely in a variant case of achalasia. The fact that the transition from DES to achalasia has been documented and is believed to occur in 3% to 5% of patients supports this observation. […] […] Although we do not know the specific mechanism through which an increase of the quantity of water induces symptoms, increment in the quantity of swallowing water may stimulate secondary peristalsis in esophagus more strongly and esophageal spasm could be provoked more easily.
#50 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
Another relatively new technologic tool is the functional lumen imaging probe (FLIP) which is increasingly being utilized as an additional diagnostic instrument in evaluating esophageal disorders. […] FLIP can identify EGJOO in the setting of spastic disorders with normal integrated relaxation pressure on HRM, which raises the suspicion that spastic disorders like jackhammer esophagus and DES are oftentimes associated with EGJOO that is not captured by HRM. […] Due to an unknown etiology of DES, most pharmacological medications are aimed at treating the symptoms with limited success rates. […] Future studies clarifying this entity could aid in better understanding of the pathophysiology of DES, leading to more effective treatment options.
#51 What Are Esophageal Spasms: Everything That You Should Know – Princeton Gastroenterology Associates
https://princetongi.com/what-are-esophageal-spasms-everything-that-you-should-know/
Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] The use of phosphodiesterase inhibitors such as sildenafil can relax your esophagus, thus relieving pain. In addition, sildenafil will also relax the lower esophageal sphincter, alleviating difficulty in swallowing. […] Your doctor can also administer botulinum toxins, which reduce acetylcholine secretion, resulting in temporary symptom relief.
#52 What Are Esophageal Spasms? – Gastroenterology Medical Associates
https://gastrospecialistsnj.com/what-are-esophageal-spasms/
The diffuse esophageal spasm occurs due to defective propagation of peristaltic waves. In diffuse esophageal spasms, there are uncoordinated contractions of several esophageal segments. These contractions result in poor propagation of the food and drinks, leading to difficulty in swallowing and regurgitation. […] Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] Some of the symptoms that suggest esophageal spasms are: Chest Pain, The pain of esophageal spasms is felt at the center of the chest.
#53 What Are Esophageal Spasms: Everything That You Should Know – Princeton Gastroenterology Associates
https://princetongi.com/what-are-esophageal-spasms-everything-that-you-should-know/
Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] The use of phosphodiesterase inhibitors such as sildenafil can relax your esophagus, thus relieving pain. In addition, sildenafil will also relax the lower esophageal sphincter, alleviating difficulty in swallowing. […] Your doctor can also administer botulinum toxins, which reduce acetylcholine secretion, resulting in temporary symptom relief.
#54 What Are Esophageal Spasms? – Gastroenterology Medical Associates
https://gastrospecialistsnj.com/what-are-esophageal-spasms/
The diffuse esophageal spasm occurs due to defective propagation of peristaltic waves. In diffuse esophageal spasms, there are uncoordinated contractions of several esophageal segments. These contractions result in poor propagation of the food and drinks, leading to difficulty in swallowing and regurgitation. […] Although the exact cause of esophageal spasm is not well established, several theories explain the initiating event: Uncoordinated brain signals, Primary motor nerve disorders, Increased release of neurotransmitter acetylcholine due to unknown mechanism, Gastroesophageal reflux disease: long-standing gastroesophageal can lead to spasms, especially when the esophagus is narrowing. […] Some of the symptoms that suggest esophageal spasms are: Chest Pain, The pain of esophageal spasms is felt at the center of the chest.
#55
https://grantome.com/index.php/grant/NIH/R01-DK060733-12
Seventy percent of patients coming to the emergency room with chest pain have normal coronary arteries and thus have non-cardiac pain. Esophagus is suspected to be the cause of pain in these patients. Gastro-esophageal reflux and esophageal spasm are 2 possible major causes of esophageal pain. […] One of the possible causes of chest pain in these patients is esophageal spasm, however large number of studies conducted in 1990’s failed to identify abnormal motor event at the time of pain. Current thinking is that esophageal hypersensitivity, central or peripheral, is the cause of pain in these patients. […] How does longitudinal muscle spasm cause pain? We propose that muscle spasm induces ischemia of the wall of the esophagus. […] Our preliminary studies show that esophageal wall ischemia related to prolonged contraction of the longitudinal muscles of the esophagus is temporally related to esophageal pain/heartburn. We use novel technique of ambulatory high resolution manometry to demonstrate the temporal correlation between esophageal pain and longitudinal muscle spasm. Laser Doppler technique is used to study the effects of esophageal contractions on the esophageal blood flow to demonstrate temporal correlation between esophageal pain and esophageal wall ischemia in humans.
#56 Esophageal Spasm | Memorial Hermann
https://memorialhermann.org/services/conditions/esophageal-spasm
Simultaneous esophageal spasms are uncoordinated contractions of the muscles in the esophagus that â instead of pushing food through to the stomach â are ineffective and prevent normal esophageal movement. […] It is unclear what causes these poorly coordinated esophageal spasms. However, some common triggers have been identified, like very cold or very hot foods or liquids. Women and patients with baseline anxiety disorders are more prone to diffuse esophageal spasms. […] High resolution manometry or a videoesophagram can demonstrate the ineffective contractions and diagnose diffuse esophageal spasm. […] Diffuse esophageal spasm is usually a mild disease and might not require any treatment. Prevention by avoiding triggers can be sufficient. In severe cases, smooth-muscle relaxers like sublingual nitroglycerin, as well as long-acting forms of nitroglycerin, can be used. Calcium channel blockers and antidepressants also have been used and can be effective for maintenance therapy. In rare cases, surgery to cut the spastic muscle of the esophagus may be necessary for esophageal spasm treatment.
#57 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
The relationship between DES and gastroesophageal reflux disease (GERD) is an area of continued debate. […] DES has also been linked to psychiatric conditions. […] Spastic esophageal disorders including DES are encountered more frequently in the setting of narcotics use. […] Opiates inhibit the neuronal excitability that leads to secretion of inhibitory neurotransmitters like NO and vasoactive intestinal peptide. […] This decreases the latency gradient in the distal esophagus, and results in simultaneous high-amplitude contraction (DES); and failure of LES to relax. […] DES and spastic achalasia (achalasia type 3) appear to share a common pathophysiologic pathway. […] The phenomenon of pseudo-relaxation may result from esophageal shortening during swallowing, and the actual LES to move upward along the catheter, leading the distal pressure sensor to measure the intragastric pressure rather than the actual LES pressure.
#58 Esophageal Spasms And Anxiety – AnxietyCentre.com
https://www.anxietycentre.com/anxiety-disorders/symptoms/esophageal-spasms-anxiety/
Esophageal spasms are sudden muscle contractions (spasms) in the esophagus, which is the tube linking your throat to your stomach. […] Anxious behavior activates the bodyâs stress response, causing many physiological, psychological, and emotional changes that prepare the body for immediate, emergency action â to either fight or flee. […] Any of the above changes can cause muscle tremors, twitching, and spasms, including the esophagus for some people since the esophagus is a muscle. […] Some anxious people get esophageal spasms due to acute stress, such as from acute anxiety. […] Esophageal spasms are a common indication of hyperstimulation (chronic stress) for some people. […] Anxiety and depression are common causes of esophageal spasms. […] When esophageal spasms are caused by apprehensive behavior and the accompanying stress response changes, calming yourself down will end the active stress response and its changes. […] When this symptom is caused by hyperstimulation, eliminating hyperstimulation will end this symptom. […] Chronic anxiety symptoms subside when hyperstimulation is eliminated.
#59 Esophageal Spasms And Anxiety – AnxietyCentre.com
https://www.anxietycentre.com/anxiety-disorders/symptoms/esophageal-spasms-anxiety/
Esophageal spasms are sudden muscle contractions (spasms) in the esophagus, which is the tube linking your throat to your stomach. […] Anxious behavior activates the bodyâs stress response, causing many physiological, psychological, and emotional changes that prepare the body for immediate, emergency action â to either fight or flee. […] Any of the above changes can cause muscle tremors, twitching, and spasms, including the esophagus for some people since the esophagus is a muscle. […] Some anxious people get esophageal spasms due to acute stress, such as from acute anxiety. […] Esophageal spasms are a common indication of hyperstimulation (chronic stress) for some people. […] Anxiety and depression are common causes of esophageal spasms. […] When esophageal spasms are caused by apprehensive behavior and the accompanying stress response changes, calming yourself down will end the active stress response and its changes. […] When this symptom is caused by hyperstimulation, eliminating hyperstimulation will end this symptom. […] Chronic anxiety symptoms subside when hyperstimulation is eliminated.
#60 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Multiple sclerosis (MS) is an inflammatory disease characterized by the demyelination of primarily the central nervous system. […] Mechanisms involving dysfunction of the pre- and post-ganglionic nerve fibers of the myenteric plexus have been proposed. […] Patients with MS have higher odds of developing achalasia or DES compared to patients without MS. […] This suggests that these patients have a more severe disease phenotype in regards to the extent of neuronal degradation and demyelination causing the autonomic dysfunction. […] Degeneration of the myenteric plexus is a well-known histopathological finding in achalasia; the degree of T cell infiltration, which is thought to be the cause of esophageal inflammation and fibrosis, is inversely correlated with the number of preserved ganglia.
#61 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Multiple sclerosis (MS) is an inflammatory disease characterized by the demyelination of primarily the central nervous system. […] Mechanisms involving dysfunction of the pre- and post-ganglionic nerve fibers of the myenteric plexus have been proposed. […] Patients with MS have higher odds of developing achalasia or DES compared to patients without MS. […] This suggests that these patients have a more severe disease phenotype in regards to the extent of neuronal degradation and demyelination causing the autonomic dysfunction. […] Degeneration of the myenteric plexus is a well-known histopathological finding in achalasia; the degree of T cell infiltration, which is thought to be the cause of esophageal inflammation and fibrosis, is inversely correlated with the number of preserved ganglia.
#62 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Given the impaired LES relaxation seen in achalasia, the inflammatory process is thought to be selective for inhibitory neurons crucial for normalizing resting smooth muscle tone. […] Several studies investigating the role of nitric oxide (NO) have shown that artificial inhibition of NO synthase mimic physiological findings seen in achalasia. […] DES also shows similar findings of impaired inhibitory neurons leading to inappropriate esophageal contractions, with several studies showing absence of deglutitive inhibition and restoration of function with NO production. […] Both achalasia and DES share a common proposed mechanism of impaired inhibitory innervation of the esophagus. […] We believe that the mechanism behind the relationship between achalasia and MS is driven by similar environmental triggers such as viral infections, and T cell autoimmunity directed at pre and post-ganglionic neurons. Thus, susceptibility to one increases the risk for the other via a shared underlying mechanism. […] Although the etiology of DES is incompletely understood with multiple theories proposed, most experts agree that impaired inhibitory innervation by malfunction of endogenous NO synthesis is the predominant mechanism.
#63 Diffuse esophageal spasm pathophysiology – wikidoc
https://wikidoc.org/index.php/Diffuse_esophageal_spasm_pathophysiology
The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neurons in DES. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation. Inhibitory neurotransmitters are nitric oxide (NO), vaso-active intestinal peptide (VIP) and ATP whereas excitatory neurotransmitter are acetyl choline (ACh), glutamate and substance P. Anti-ganglionic acetylcholine receptor antibodies (anti-gAChR-Abs) are reported in some cases. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus. […] There are reports of families with Achalasia and esophageal spasm which supports the hypothesis that genetic traits may play role in pathogenesis of DES as well as association between the two disorders. However, genetic inheritance is not fully established.
#64 A Review of Esophageal Chest Pain â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/november-2015/a-review-of-esophageal-chest-pain/
Several mechanisms have been proposed, and it is likely that the pathogenesis of ECP is multifactorial and heterogeneous. In a given patient, one or more mechanisms may be involved. […] ECP is often presumed to be due to GERD, and the pain may be mediated by activation of esophageal chemoreceptors. […] Several motility disorders have been implicated in the pathogenesis of ECP, including diffuse esophageal spasm, nutcracker esophagus, achalasia, scleroderma, and nonspecific motility disorders. […] Esophageal hypersensitivity refers to a sensory dysfunction in which patients experience discomfort or pain at thresholds that are significantly lower than those experienced by healthy controls. Esophageal hypersensitivity is believed to be a key mechanism for ECP and considered a hallmark of this condition. […] Recent studies suggest that pain perception in ECP may be due to central sensitization and that N-methyl-D-aspartate (NMDA) blockers may alter chest pain.
#65 Hypercontractile (Nutcracker) Esophagus: Symptoms, Causes, and More
https://www.healthline.com/health/nutcracker-esophagus
Hypercontractile esophagus is a motility disorder in which there is abnormal movement and function of the esophagus. […] Hypercontractile esophagus occurs when 20% of your esophageal contractions have a distal contractile integral (DCI) of more than 8000 mm Hg cm/s. DCI calculates the force, length, and duration of esophageal contractions. […] The exact cause of hypercontractile esophagus is unknown. […] A 2022 review found that spinal injury, hiatal hernia, and vagus nerve problems may also have a link with hypercontractile esophagus. […] Hypercontractile esophagus is diagnosed using high-resolution manometry. […] However, research on treating hypercontractile esophagus is limited, and more research is needed to establish the best treatment. […] The exact cause of esophageal spasms is unknown. […] Some ways to quickly calm an esophageal spasm include taking nitroglycerin or calcium channel blockers.
#66 A Review of Esophageal Chest Pain â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/november-2015/a-review-of-esophageal-chest-pain/
Several mechanisms have been proposed, and it is likely that the pathogenesis of ECP is multifactorial and heterogeneous. In a given patient, one or more mechanisms may be involved. […] ECP is often presumed to be due to GERD, and the pain may be mediated by activation of esophageal chemoreceptors. […] Several motility disorders have been implicated in the pathogenesis of ECP, including diffuse esophageal spasm, nutcracker esophagus, achalasia, scleroderma, and nonspecific motility disorders. […] Esophageal hypersensitivity refers to a sensory dysfunction in which patients experience discomfort or pain at thresholds that are significantly lower than those experienced by healthy controls. Esophageal hypersensitivity is believed to be a key mechanism for ECP and considered a hallmark of this condition. […] Recent studies suggest that pain perception in ECP may be due to central sensitization and that N-methyl-D-aspartate (NMDA) blockers may alter chest pain.
#67 Hypercontractile (Nutcracker) Esophagus: Symptoms, Causes, and More
https://www.healthline.com/health/nutcracker-esophagus
Hypercontractile esophagus is a motility disorder in which there is abnormal movement and function of the esophagus. […] Hypercontractile esophagus occurs when 20% of your esophageal contractions have a distal contractile integral (DCI) of more than 8000 mm Hg cm/s. DCI calculates the force, length, and duration of esophageal contractions. […] The exact cause of hypercontractile esophagus is unknown. […] A 2022 review found that spinal injury, hiatal hernia, and vagus nerve problems may also have a link with hypercontractile esophagus. […] Hypercontractile esophagus is diagnosed using high-resolution manometry. […] However, research on treating hypercontractile esophagus is limited, and more research is needed to establish the best treatment. […] The exact cause of esophageal spasms is unknown. […] Some ways to quickly calm an esophageal spasm include taking nitroglycerin or calcium channel blockers.
#68 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
Distal esophageal spasm (DES) is thought to result from an imbalance between the nitrogenic inhibitory pathway and the cholinergic excitatory pathway in the myenteric plexus. […] The interval of deglutitive inhibition was defined as contractile latency; and it was hypothesized that a decrease in this interval would result in spontaneous contractions or spasms. […] It has also been shown that subjects receiving a nitric oxide (NO) scavenger (recombinant hemoglobin) had abnormalities in the timing of esophageal peristalsis causing simultaneous contractions along the length of smooth muscles and a decrease in contractile latency. […] This supported the hypothesis that the inhibitory pathway plays a major role in the development of DES and other spastic motility disorders. […] DES can be seen in association with other conditions.
#69 Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22173
Given the impaired LES relaxation seen in achalasia, the inflammatory process is thought to be selective for inhibitory neurons crucial for normalizing resting smooth muscle tone. […] Several studies investigating the role of nitric oxide (NO) have shown that artificial inhibition of NO synthase mimic physiological findings seen in achalasia. […] DES also shows similar findings of impaired inhibitory neurons leading to inappropriate esophageal contractions, with several studies showing absence of deglutitive inhibition and restoration of function with NO production. […] Both achalasia and DES share a common proposed mechanism of impaired inhibitory innervation of the esophagus. […] We believe that the mechanism behind the relationship between achalasia and MS is driven by similar environmental triggers such as viral infections, and T cell autoimmunity directed at pre and post-ganglionic neurons. Thus, susceptibility to one increases the risk for the other via a shared underlying mechanism. […] Although the etiology of DES is incompletely understood with multiple theories proposed, most experts agree that impaired inhibitory innervation by malfunction of endogenous NO synthesis is the predominant mechanism.
#70 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
Distal esophageal spasm (DES) is thought to result from an imbalance between the nitrogenic inhibitory pathway and the cholinergic excitatory pathway in the myenteric plexus. […] The interval of deglutitive inhibition was defined as contractile latency; and it was hypothesized that a decrease in this interval would result in spontaneous contractions or spasms. […] It has also been shown that subjects receiving a nitric oxide (NO) scavenger (recombinant hemoglobin) had abnormalities in the timing of esophageal peristalsis causing simultaneous contractions along the length of smooth muscles and a decrease in contractile latency. […] This supported the hypothesis that the inhibitory pathway plays a major role in the development of DES and other spastic motility disorders. […] DES can be seen in association with other conditions.
#71 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
The relationship between DES and gastroesophageal reflux disease (GERD) is an area of continued debate. […] DES has also been linked to psychiatric conditions. […] Spastic esophageal disorders including DES are encountered more frequently in the setting of narcotics use. […] Opiates inhibit the neuronal excitability that leads to secretion of inhibitory neurotransmitters like NO and vasoactive intestinal peptide. […] This decreases the latency gradient in the distal esophagus, and results in simultaneous high-amplitude contraction (DES); and failure of LES to relax. […] DES and spastic achalasia (achalasia type 3) appear to share a common pathophysiologic pathway. […] The phenomenon of pseudo-relaxation may result from esophageal shortening during swallowing, and the actual LES to move upward along the catheter, leading the distal pressure sensor to measure the intragastric pressure rather than the actual LES pressure.
#72 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
The relationship between DES and gastroesophageal reflux disease (GERD) is an area of continued debate. […] DES has also been linked to psychiatric conditions. […] Spastic esophageal disorders including DES are encountered more frequently in the setting of narcotics use. […] Opiates inhibit the neuronal excitability that leads to secretion of inhibitory neurotransmitters like NO and vasoactive intestinal peptide. […] This decreases the latency gradient in the distal esophagus, and results in simultaneous high-amplitude contraction (DES); and failure of LES to relax. […] DES and spastic achalasia (achalasia type 3) appear to share a common pathophysiologic pathway. […] The phenomenon of pseudo-relaxation may result from esophageal shortening during swallowing, and the actual LES to move upward along the catheter, leading the distal pressure sensor to measure the intragastric pressure rather than the actual LES pressure.
#73 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
Another relatively new technologic tool is the functional lumen imaging probe (FLIP) which is increasingly being utilized as an additional diagnostic instrument in evaluating esophageal disorders. […] FLIP can identify EGJOO in the setting of spastic disorders with normal integrated relaxation pressure on HRM, which raises the suspicion that spastic disorders like jackhammer esophagus and DES are oftentimes associated with EGJOO that is not captured by HRM. […] Due to an unknown etiology of DES, most pharmacological medications are aimed at treating the symptoms with limited success rates. […] Future studies clarifying this entity could aid in better understanding of the pathophysiology of DES, leading to more effective treatment options.
#74 Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry
https://www.wjgnet.com/2307-8960/full/v8/i6/1026.htm
Another relatively new technologic tool is the functional lumen imaging probe (FLIP) which is increasingly being utilized as an additional diagnostic instrument in evaluating esophageal disorders. […] FLIP can identify EGJOO in the setting of spastic disorders with normal integrated relaxation pressure on HRM, which raises the suspicion that spastic disorders like jackhammer esophagus and DES are oftentimes associated with EGJOO that is not captured by HRM. […] Due to an unknown etiology of DES, most pharmacological medications are aimed at treating the symptoms with limited success rates. […] Future studies clarifying this entity could aid in better understanding of the pathophysiology of DES, leading to more effective treatment options.
#75 KoreaMed Synapse
https://synapse.koreamed.org/articles/1006983
Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. […] 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. […] Although the pathophysiology and etiology remain uncertain, the suggested pathophysiology of ES includes cholinergic, nitregic, and reflux mechanisms. […] The pathogenesis of DES is unclear, but studies suggest altered endogenous nitric oxide (NO) synthesis or degradation. […] Many animal and human studies have suggested that NO plays an important role in maintaining esophageal peristalsis. […] Although this new methodology is useful for evaluating esophageal motor function, more studies are required to refine the diagnostic criteria and resolve uncertain issues.
#76 KoreaMed Synapse
https://synapse.koreamed.org/articles/1006983
Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. […] 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. […] Although the pathophysiology and etiology remain uncertain, the suggested pathophysiology of ES includes cholinergic, nitregic, and reflux mechanisms. […] The pathogenesis of DES is unclear, but studies suggest altered endogenous nitric oxide (NO) synthesis or degradation. […] Many animal and human studies have suggested that NO plays an important role in maintaining esophageal peristalsis. […] Although this new methodology is useful for evaluating esophageal motor function, more studies are required to refine the diagnostic criteria and resolve uncertain issues.
#77 Distal Esophageal Spasm: An Updated Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10404380/
The pathophysiology likely involves an imbalance between the inhibitory and excitatory pathways of the smooth muscles. […] Further research is needed to elucidate the underlying mechanisms of DES and to develop more effective treatment strategies to alleviate symptoms and improve the quality of life for affected individuals.