gastrointestinal disorders
Diffuse Esophageal Spasm
Diagnosis of Diffuse Esophageal Spasm
Coronary ischemia ruled out Barium swallow Esophageal manometry Alternative diagnoses include coronary ischemia, which always needs to be excluded by appropriate testing (eg, ECG, cardiac markers, stress testing—see Diagnosis ). Definitive confirmation of an esophageal origin for symptoms is difficult. Barium swallow may show poor progression of a bolus and disordered, simultaneous contractions or tertiary contractions. Severe spasms may mimic the radiographic appearance of diverticula but vary in size and position. Typically, barium swallow is done before manometry because it can be used to find other causes of symptoms and is less invasive. Manometry provides the most specific description of the spasms. At least 20% of test swallows must have a short distal latency (< 4.5 seconds) to meet manometric criteria for diffuse esophageal spasm. However, spasms may not occur during testing. Esophageal scintigraphy and provocative tests with drugs (eg, edrophonium chloride 10 mg IV) have not proved helpful. 