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=== Pathogenesis ===
=== Pathogenesis ===
* The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neuron. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus.
* The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neuron. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation<ref name="pmid4196712">{{cite journal| author=Orlando RC, Bozymski EM| title=Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. | journal=N Engl J Med | year= 1973 | volume= 289 | issue= 1 | pages= 23-5 | pmid=4196712 | doi=10.1056/NEJM197307052890106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4196712  }}</ref>. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus.

Revision as of 15:31, 29 October 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel

Historical Perspective

Discovery

  • DES was first described by Osgood, in 1889 in 6 patients who presented with chest pain and dysphagia.
  • Creamer (1954) made the first manometric descriptions of DES.

Classification of DES

  • There is no established system for the classification of DES although it is categorized as one of the major disorders of peristalsis according to The Chicago Classification v.3.0.

Risk Factors

  • Common risk factors in the development of Diffuse Esophageal Spasm include Age (60-80 years), presence of GERD, Hypertension, anxiety or depression, and drinks (eg. red wine, very hot or cold liquid or fluid).

Pathophysiology

Pathogenesis

  • The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neuron. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation[1]. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus.
  1. Orlando RC, Bozymski EM (1973). "Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm". N Engl J Med. 289 (1): 23–5. doi:10.1056/NEJM197307052890106. PMID 4196712.