eMedicine Specialties > Gastroenterology > Esophagus

Esophageal Spasm: Follow-up

Author: Alan BR Thomson, MD, MSc, PhD, Professor, Department of Medicine, Division of Gastroenterology, University of Alberta Faculty of Medicine
Contributor Information and Disclosures

Updated: Aug 26, 2009

Follow-up

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.

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.

Inpatient & Outpatient Medications

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

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.

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • As with any medical problem, a thorough systematic workup should be performed in patients with symptoms consistent with esophageal spasm. Manometry is the criterion standard, with a high sensitivity and high specificity. Chest pain deserves consideration of cardiac, pulmonary, and rheumatologic etiologies.
  • Failure to exclude serious causes of chest pain (eg, coronary artery disease) and inappropriate treatment of DES without excluding another primary or associated etiology may lead to mortality or further morbidity.
  • CT scan images can demonstrate thickening of the esophagus in patients with esophageal spasm or patients with other diseases of the esophagus, such as carcinoma. Therefore, abnormal findings on a CT scan should be followed by endoscopy and manometry if esophageal spasm is a concern.
  • Specific diagnosis should be made prior to operative intervention. Performing a myotomy in a patient with nutcracker esophagus worsens the dysphagia without improving the pain.
  • Reflux can mimic esophageal spasm; therefore, this should be ruled out or treated prior to instigating other treatments.
 


More on Esophageal Spasm

Overview: Esophageal Spasm
Differential Diagnoses & Workup: Esophageal Spasm
Treatment & Medication: Esophageal Spasm
Follow-up: Esophageal Spasm
Multimedia: Esophageal Spasm
References
Further Reading
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References

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Further Reading

Related eMedicine Topics

Clinical Trials

National Guideline Clearinghouse

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Keywords

esophageal spasm, diffuse esophageal spasm, nutcracker esophagus, DES, dysphagia, regurgitation, achalasia, noncardiac chest pain, esophagectomy, globus, gastric reflux, gastric reflux, microvascular compression of Vagus nerve

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Contributor Information and Disclosures

Author

Alan BR Thomson, MD, MSc, PhD, Professor, Department of Medicine, Division of Gastroenterology, University of Alberta Faculty of Medicine
Alan BR Thomson, MD, MSc, PhD is a member of the following medical societies: American Federation for Aging Research, American Federation for Clinical Research, American Gastroenterological Association, American Geriatrics Society, American Physiological Society, Canadian Association of Gastroenterology, Gastroenterology Research Group, New York Academy of Sciences, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

Alex J Mechaber, MD, FACP, 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; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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