Diffuse Esophageal Spasm

  I have been diagnosed as having Diffuse Esophageal Spasm and would like any information you have on stopping the severe chest pain.  I have had a stress test and all cardiac problems have been ruled out.  I have had several attacks after and during exercise and sometimes just sleeping.  The pain on a scale of 1 to 10 is a 12!  They last anywhere from 45 minutes to 3 hours.  I have taken sublingual Nitro with no reduction of pain and have now been prescribed slow release acting nitro that also does not reduce the pain.  I would prefer not to be on drugs all the time but if there are any ideas on how I can stop the pain when I am having an attack it would be greatfully appreciated.
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Dear Scott Fisher,
As you are aware diffuse esophageal spasm is a condition of unknown etiology in which there are simultaneous high pressure, longer than normal contractions of muscles at different levels in the esophagus.  The presenting symptoms of diffuse esophageal spasm can include pressure pains in the chest behind the breast bone and/or pain with swallowing and the sensation that swallowed materials (either solids or liquids) stick in the esophagus.  Because symptoms can be induced by ingesting hot or cold materials, these substances should be avoided.
To date, medical therapy has focused  on the use of medicines that cause relaxation of the esophageal smooth muscle.  Nitroglycerine has been studied.  Unfortunately, the results do not indicate a potent effect of this therapy.  Calcium channel antagonists, another smooth muscle relaxant group of drugs, has also been tried and also failed to improve symptoms.  Some physicians try anxiolytics whereas others suggest acupuncture.  To date, there are no published studies to indicate whether these therapies work.
During the last few years there have been several reports that myotomy (cutting the muscle of the esophagus) can improve symptoms of diffuse esophageal spasm.  The recent evidence that this procedure can be performed safely by a laparoscopic technique (with the reduced pain and shortened hospital stay compared to an open procedure) has lead to several centers providing this surgery.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of esophageal disorders, by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: diffuse esophageal spasm, motility disorders, chest pain, myotomy, esophageal surgery
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