Let us move on to Diffuse
Esophageal Spasms, DES.
Before we move on,
dissect the name DES.
Diffuse - the entire esophagus undergoes seizures,
the entire esophagus undergoing seizures.
Wow, you’ve lost the normal peristaltic activity;
you’re taking-- you brushed this morning?
So you probably don’t want to smell my breath--
wait, that’s not my point, I’m being silly.
You have toothpaste, toothpaste.
You squeeze your toothpaste, as you do so, paste comes
out in a nice smooth coordinated propulsive movement.
In DES, you’ve lost it.
The whole esophagus is
undergoing crazy spasms.
Normal peristalsic replaced by
phasic non-propulsive contraction.
Symptoms would be what
kind of dysphagia here?
Chest pain worsens with
cold and hot liquids.
Keep that in mind.
That’s an important, important diagnostic measure, or exercise
that you can do, in which you could easily identify DES.
Swallow, the barium swallow may
show a cork-screw esophagus.
So couple of barium swallows
that we’ve seen already.
We did apple core, we did apple core
in which you then have constriction
that’s taking place of your esophagus with esophageal cancer.
Next, we did our dilation of your esophagus
proximally, achalasia, barium swallow.
Barium swallow here, with diffuse esophageal
spasms, results in a cork-screw type of appearance.
Medical therapy with smooth muscle
relaxation; unpredictable because you
don’t know as to whether or not it is
actually going to relieve the spasms.
And manometry will be normal in
the asymptomatic period but when
the patient actually has these spasms intermittently; it totally
messes up the normal manometric pressure from the proximal
to the distal, because there is no proper coordinated contraction.
Now it’s actual spasm.
If you take a look at the upper endoscopy here, you’ll
notice, upon barium swallow, you don’t have your
swallow… you don’t have the barium partly being coordinated
in terms of transmitting through the esophagus.
So with this type of spasms taking place, it looks like
a cork-screw type of appearance upon barium swallow.