“Cork screw” apperance of esophagus is seen in?
Correct Answer: Diffuse esophageal spasm
Description: Ans. C. Diffuse esophageal spasm. (Ref. Bailey and Love 24th! Fig. 50.67)Diffuse oesophageal spasm is a condition in which there are incoordinate contractions of the oesophagus causing dysphagia and chest pain. The condition may be dramatic with spastic pressures on manometry of 400-500 mmHg, marked hypertrophy of the circular muscle and a corkscrew oesophagus on barium swallow.Discussion:DIFFUSE ESOPHAGEAL SPASMEssentials of Diagnosis:# Dysphagia.# Chest pain.# Intermittent symptoms.# Radiologic evidence of tertiary contractions (corkscrew esophagus).# Intermittent normal and absent peristaltic waves on manometry (> 10%, < 100%).# Normal 24-hour ambulatory pH monitoring.SYMPTOMS AND SIGNSThe most common symptom is intermittent chest pain, which varies from slight discomfort to severe spasmodic pain that simulates the pain of coronary artery disease. Most patients complain of dysphagia, but weight loss is uncommon.IMAGING STUDIES:The barium swallow is abnormal in 70% of patients. Fluoroscopic studies show segmental spasms, areas of narrowing, and irregular uncoordinated peristalsis (corkscrew esophagus) in about 30% of patients. An epiphrenic diverticulum is sometimes present.MANOMETRY:Manometry is the key for the diagnosis of DES. The classic manometric findings are:1) alternation of esophageal peristalsis and simultaneous contractions (> 10% and < 100%). Contrary to old beliefs, the contractions are not hypertensive but of normal or even low amplitude; and2) normal LES function or abnormalities similar to those seen in achalasia (elevated testing pressure and decreased relaxation in response to swallowing).Rx:Dysphagia due to diffuse spasm may respond to forceful dilatation of the cardia, but the results are not as predictable as in achalasia. In very severe cases extended oesophageal myotomy up to the aortic arch may be required. Surgical Rx of diffuse spasm is more successful in improving dysphagia than chest pain and caution should be exercised in patients in whom chest pain is the only symptom.NUTCRACKER OESOPHAGUSNutcracker oesophagus is a condition in which peristaltic pressures greater than 180 mmHg are developed. It is said to cause chest pain, but there is still some debate as to whether it is a real disorder.SCLERODERMAHypoperistalsis of the oesophagus occurs in the CREST variant of systemic sclerosis,in severe GORD and sometimes for no obvious cause. Simultaneous oesophageal manometry and radiological studies have shown that a peristaltic pressure of about 30 mmHg is required to propel a bolus down the oesophagus. Peristaltic failure may cause dysphagia in its own right, but can also increase dysphagia if there is any organic obstruction. Rx aims at excluding organic obstruction and trying to improve the force of peristalsis with prokinetic agents such as cisapride.
Category:
Radiology
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