Diffuse esophageal spasm medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
*Patients with  are treated with calcium channel blockers if dysphagia is predominant , whereas patients with predominant chest pain are treated with either calcium channel blockers or tricyclic antidepressants.
*Patients with  are treated with calcium channel blockers if dysphagia is predominant , whereas patients with predominant chest pain are treated with either calcium channel blockers or tricyclic antidepressants.
*Nitrate releasing drugs and local injection of botox toxin are used if above measures fail.
*Nitrate releasing drugs and local injection of Botox toxin are used if above measures fail.
*Proton pump inhibitors are used in secondary DES.
*Proton pump inhibitors are used in secondary DES.
===Diffuse esophageal spasm===
===Diffuse esophageal spasm===
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* '''1 Primary DES'''
* '''1 Primary DES'''
** 1.1 '''Adult'''
** 1.1 '''Adult'''
*** Preferred regimen (1): [[drug name|diltiazem]] 180-240 mg PO q24h for 7-10 days. '''(Contraindications: Hypersensitivity, AV block (2nd or 3rd degree), hypotension, acute MI)'''   
*** Preferred regimen (1): [[drug name|Diltiazem]] 180-240 mg PO q24h for 7-10 days. '''(Contraindications: Hypersensitivity, AV block (2nd or 3rd degree), hypotension, acute MI)'''   
*** Preferred regimen (2): imipramine 25-50 mg at bedtime for 14-21 days.
*** Preferred regimen (2): Imipramine 25-50 mg at bedtime for 14-21 days.
*** Alternative regimen (2):Isosorbide 10 mg or sildenafil 50 mg PO as needed.
*** Alternative regimen (1): Isosorbide 10 mg or sildenafil 50 mg PO as needed.
** 1.2 '''Pediatric'''         
** 1.2 '''Pediatric'''         
**** Preferred regimen (1): diltiazem 1.5-2mg/kg 50 mg/kg PO in 3-4 divided doses.       
**** Preferred regimen (1): Diltiazem 1.5-2mg/kg 50 mg/kg PO in 3-4 divided doses.       
**** Preferred regimen (2): imipramine 10-25 mg PO per day at bedtime. (maximum, 50mg/day if 6 years to < 12 years and 75mg/day if = or > 12 years).       
**** Preferred regimen (2): Imipramine 10-25 mg PO per day at bedtime. (maximum, 50mg/day if 6 years to < 12 years and 75mg/day if = or > 12 years).       


* '''2 Secondary DES (treatment of GERD)'''
* '''2 Secondary DES (treatment of GERD)'''
**2.1 '''Adult'''
**2.1 '''Adult'''
*** Preferred regimen (1): omeprazole 20mg PO q24h for 4 weeks  
*** Preferred regimen (1): Omeprazole 20mg PO q24h for 4 weeks  
**2.2  '''Pediatric for =<1 year and >= 16yrs'''
**2.2  '''Pediatric for =<1 year and >= 16yrs'''
*** Preferred regimen (1): 5kg to <10 kg; omeprazole 5mg PO q24h for 4 weeks
*** Preferred regimen (1): 5kg to <10 kg; Omeprazole 5mg PO q24h for 4 weeks
*** 10kg to ,20 kg; omeprazole 10mg PO q24h for 4 weeks
*** 10kg to ,20 kg; Omeprazole 10mg PO q24h for 4 weeks
*** >= 20 kg; omeprazole 20mg PO q24h for 4 weeks.
*** >= 20 kg; Omeprazole 20mg PO q24h for 4 weeks.


* ''' Refractory cases'''
* ''' Refractory cases'''

Revision as of 14:39, 20 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]

Overview

The mainstay of treatment for DES is medical therapy with calcium channel blockers, and/or tricyclic antidepressants.

Medical Therapy

  • Patients with are treated with calcium channel blockers if dysphagia is predominant , whereas patients with predominant chest pain are treated with either calcium channel blockers or tricyclic antidepressants.
  • Nitrate releasing drugs and local injection of Botox toxin are used if above measures fail.
  • Proton pump inhibitors are used in secondary DES.

Diffuse esophageal spasm

  • 1 Primary DES
    • 1.1 Adult
      • Preferred regimen (1): Diltiazem 180-240 mg PO q24h for 7-10 days. (Contraindications: Hypersensitivity, AV block (2nd or 3rd degree), hypotension, acute MI)
      • Preferred regimen (2): Imipramine 25-50 mg at bedtime for 14-21 days.
      • Alternative regimen (1): Isosorbide 10 mg or sildenafil 50 mg PO as needed.
    • 1.2 Pediatric
        • Preferred regimen (1): Diltiazem 1.5-2mg/kg 50 mg/kg PO in 3-4 divided doses.
        • Preferred regimen (2): Imipramine 10-25 mg PO per day at bedtime. (maximum, 50mg/day if 6 years to < 12 years and 75mg/day if = or > 12 years).
  • 2 Secondary DES (treatment of GERD)
    • 2.1 Adult
      • Preferred regimen (1): Omeprazole 20mg PO q24h for 4 weeks
    • 2.2 Pediatric for =<1 year and >= 16yrs
      • Preferred regimen (1): 5kg to <10 kg; Omeprazole 5mg PO q24h for 4 weeks
      • 10kg to ,20 kg; Omeprazole 10mg PO q24h for 4 weeks
      • >= 20 kg; Omeprazole 20mg PO q24h for 4 weeks.
  • Refractory cases
  • Cases refractory to above treatment,endoscopic injection of Botulinum toxin 100U is the next medical therapy.


References

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