GASTROENTEROLOGY ARTICLE OF THE WEEK
March 5, 2009
Grubel C, Borovicka J, Schwizer W. Diffuse esophageal spasm. Am J Gastroenterol 2008;103:450-457.
1. The classical manometric definition of DES is
a. Elevated LESP with simultaneous esophageal contractions of <30mmHg amplitude
b. Any evidence of high amplitude simultaneous esophageal contractions
c. 20% or more contractions are simultaneous, have an amplitude >30mmHg and co-exist with normal peristalsis in the tracing
d. Normal LESP associated with esophageal contractions that are peristaltic but exceed 180mmHg pressure.
2. The classic radiologic finding of DES on barium swallow is:
a. Birds-beak distal narrowing with dilated esophagus
b. Epiphrenic diverticulum
c. Patulous LES with severe reflux of barium and no peristaltic activity
d. Corkscrew esophagus
3. The neurotransmitter believed to be most likely responsible for the findings in DES is:
a. acetylcholine
b. epinephrine
c. VIP
d. NO
True or False
4. DES is usually an intermittent non-progressive disease that often improves with time
5. Esophageal spasm is one of the most common causes of non-cardiac chest pain once GERD has been excluded
6. Surgical therapy for DES is the Heller myotomy
7. Over 50% of patients with epiphrenic diverticula on EGD are found to have esophageal spasm on subsequent testing
8. Abnormalities of the myenteric plexus are consistently found in patients with DES
9. Botulinum toxin injection in the body of the esophagus may relieve symptoms in a subset of patients with DES
10. Calcium channel blockers and nitrates are usually not useful in the treatment of DES