Diffuse Esophageal Spasm

00:01 Let us move on to Diffuse Esophageal Spasms, DES.

00:07 Before we move on, dissect the name DES.

00:10 Diffuse - the entire esophagus undergoes seizures, the entire esophagus undergoing seizures.

00:18 Wow, you’ve lost the normal peristaltic activity; you’re taking-- you brushed this morning? I didn’t.

00:28 So you probably don’t want to smell my breath-- wait, that’s not my point, I’m being silly.

00:30 You have toothpaste, toothpaste.

00:33 You squeeze your toothpaste, as you do so, paste comes out in a nice smooth coordinated propulsive movement.

00:41 In DES, you’ve lost it.

00:43 The whole esophagus is undergoing crazy spasms.

00:47 Normal peristalsic replaced by phasic non-propulsive contraction.

00:51 Symptoms would be what kind of dysphagia here? Intermittent dysphagia.

00:57 Chest pain worsens with cold and hot liquids.

00:59 Keep that in mind.

01:00 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.

01:31 Next, we did our dilation of your esophagus proximally, achalasia, barium swallow.

01:40 Barium swallow here, with diffuse esophageal spasms, results in a cork-screw type of appearance.

01:47 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.

01:54 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.

02:14 Now it’s actual spasm.

02:17 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.

02:29 So with this type of spasms taking place, it looks like a cork-screw type of appearance upon barium swallow.