Esophageal Spasm Follow-up

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 4, 2012
 

Further Inpatient Care

  • Usually, the workup and treatment are performed in an outpatient setting.
  • Patients in whom medical management fails and who require operative intervention should have routine postoperative care based on the procedure performed.
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Further Outpatient Care

  • Patients need close follow-up care upon the initiation of therapy or with a change in therapy.
  • Patients should be monitored for improvements in symptoms and for adverse effects of the medications.
  • Patients in whom medical management fails should be referred to a thoracic surgeon for possible operative intervention.
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Inpatient & Outpatient Medications

  • Calcium channel blockers and nitrates are first-line therapy.
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Complications

  • Potential problems are based on the therapy. All medications have possible adverse effects, and patients should be monitored.
  • Esophageal perforation can occur with esophageal dilatation, leading to admission to the hospital, time lost from work, and possible surgery.
  • Operative complications are the same as for any operation on the esophagus.
    • Esophageal perforation can occur during the myotomy. If a perforation of the mucosa occurs, the defect should be closed and the patient should have a contrast swallowing test prior to resuming a diet.
    • Vagal injury can occur during the dissection.
    • Other postoperative complications include wound infection, atelectasis, pneumonia, and persistent air leak.
    • Any complication of a thoracic operation or an esophageal operation can occur.
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Prognosis

  • Prognosis is moderate. Symptom scores improve over time (3 y or longer) from DES and nutcracker esophagus.
  • The mortality rate is minuscule, but the morbidity rate is high.
  • No treatment is effective in all patients. Some patients do not respond to any treatment.
  • In most patients, symptoms are controllable with a combination of treatment modalities.
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Patient Education

  • Patients should be educated about the symptoms and treatment options for the disease.
  • Patient involvement and education are crucial to the success of any treatment modality.
  • For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article BOTOX® Injections.
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Contributor Information and Disclosures
Author

Alan BR Thomson, MD  Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

John Gunn Lee, MD  Director of Pancreaticobiliary Service, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of California at Irvine School of Medicine

John Gunn Lee, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Simmy Bank, MD  Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Barium swallow demonstrates diffuse uncoordinated contractions of the esophagus in a patient with diffuse esophageal spasm.
This is normal esophageal manometry tracing with normal amplitude of the contractions. The contractions are coordinated because the contractions in the proximal esophagus (top of image) occur before the contractions further distal in the esophagus.
Esophageal manometry tracing demonstrates diffuse esophageal spasm. Note the multiple uncoordinated contractions in the third tracing from the distal esophagus.
Esophageal manometry tracing demonstrates nutcracker esophagus. Note the excessive amplitude of the contractions.
 
 
 
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