Sandbox:Madhu
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.
References
- ↑ 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.