Swallowing Disorders/Dysphagia

Diffuse Esophageal Spasm (DES)

In diffuse Esophageal Spasm (DES), abnormal spasms of the esophagus keep swallowed food from reaching the stomach. The exact cause of DES is unknown.

Symptoms include chest pain that can worsen during meals or when consuming hot foods or liquids. Patients also experience difficulty swallowing, experience heartburn, and may regurgitate food. Chest pain accompanying DES may be mistaken for heart disease.

Several different methods can be used to diagnose DES. These include barium swallowIn an upper GI series, or a barium swallow, also called barium contrast X-ray, the patient swallows a solution of barium, a compound that will appear inside the body during X-ray so the physician may observe how fluid moves through the esophagus as well as the appearance of the stomach., endoscopyIn esophagoscopy/endoscopy of the esophagus, a thin, flexible tube with a camera is inserted through the mouth into the esophagus, allowing the physician to view the interior of the esophagus and obtain small tissue samples for biopsy, if necessary. and manometryManometry involves inserting a thin tube with a sensitive probe through the nose, into the throat and esophagus. The patient is asked to swallow several times. Muscle contractions in the smooth muscle of the esophagus are analyzed at several points as the tube is slowly pulled back through the esophagus..

In some patients, the condition may be effectively treated with medication to relax the muscles of the esophagus, surgery for DES involves cutting the muscles of the lower esophagus. Usually performed laparoscopically, it may be conducted through an incision in the chest or the abdomen.

Nutcracker Esophagus

Diagram of esophageal motility in a patient with nutcracker esophagus.
Diagram of esophageal motility in a patient with nutcracker esophagus. The image on the left is a schematic of the esophagus; arrows show the location of three pressure recordings: at the upper esophagus, lower esophagus and lower esophageal sphincter. The patient's esophageal contractions are high pressure and last 6 seconds each.
Source

In nutcracker esophagus, muscles of the esophagus contract too powerfully. The condition is frequently related to GERD. Symptoms include chest pain, difficulty swallowing, and heartburn. The condition is diagnosed through manometryManometry involves inserting a thin tube with a sensitive probe through the nose, into the throat and esophagus. The patient is asked to swallow several times. Muscle contractions in the smooth muscle of the esophagus are analyzed at several points as the tube is slowly pulled back through the esophagus. or esophagoscopy/endoscopyIn esophagoscopy/endoscopy of the esophagus, a thin, flexible tube with a camera is inserted through the mouth into the esophagus, allowing the physician to view the interior of the esophagus and obtain small tissue samples for biopsy, if necessary..

When the condition is related to GERD, treatment of reflux symptoms is often effective. In other cases, medications to relax the muscles of the esophagus and stomach can sometimes be effective.

Scleroderma

A chronic connective tissue disease, scleroderma can cause the tightening or thickening of skin, blood vessels and damage to internal organs and can damage and decrease the muscle layers in the esophagus, inhibiting the ability of the esophagus to adequately empty as well was causing gastroesophageal reflux disease (GERD).

Symptoms if the esophagus is affected by scleroderma include difficulty swallowing, GERD, chest pain, and an acid taste in the mough.

In addition to a physical examination, diagnosis may include esophagoscopyIn esophagoscopy/endoscopy of the esophagus, a thin, flexible tube with a camera is inserted through the mouth into the esophagus, allowing the physician to view the interior of the esophagus and obtain small tissue samples for biopsy, if necessary., barium swallowIn an upper GI series, or a barium swallow, also called barium contrast X-ray, the patient swallows a solution of barium, a compound that will appear inside the body during X-ray so the physician may observe how fluid moves through the esophagus as well as the appearance of the stomach. and esophageal manometryManometry involves inserting a thin tube with a sensitive probe through the nose, into the throat and esophagus. The patient is asked to swallow several times. Muscle contractions in the smooth muscle of the esophagus are analyzed at several points as the tube is slowly pulled back through the esophagus..

Scleroderma symptoms may be controlled with medication, with surgery as a last resort for patients who don't respond to medication. Surgery involves fundoplication to strengthen the connection between the esophagus and the stomach may become an option on occasion if medications fail to control symptoms of scleroderma.

Columbia University Medical Center       New York Presbyterian Hospital
info@columbiasurgery.org Follow Us On Twitter Join Us On Facebook Read Our Blog Visit Our Youtube Channel Expert Health Information - Sharecare.com Find us on Google+