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Esophageal Disorders and Their Relationship to Psychiatric Disease
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Laurence A. Bradley, Joel E. Richter
Esophageal pneumatic dilation and myotomy have been used in some patients with diffuse esophageal spasm and other motility disorders (65,66). However, the potential risks and limited benefits of these procedures for patients with spastic motility disorders suggest that great care must be taken in their usage. We have previously suggested that pneumatic dilation be performed only with patients with documented delays in esophageal emptying and that myotomy is appropriate only for patients with significant chest pain, dysphagia, and disability who do not respond to first-line treatments (4). Physicians may also consider referring unresponsive patients for behavioral therapies before recommending pneumatic dilatation or surgery. These therapies have not been tested in controlled clinical trials, but case studies suggest that they may be effective, especially for patients with diffuse esophageal spasm (67).
The upper gastrointestinal tract, common conditions, and recommended treatments
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Patients with oesophageal spasm may complain of difficulty swallowing or chest pain. Oesophageal spasm is believed to be due to degeneration of the nerves of the oesophagus, and there is some overlap with achalasia (see earlier). Treatment is with acid suppression (acid reflux can precipitate spasm), medications that relax the oesophageal muscle (nitrates and calcium-channel antagonists), and pain relief, avoiding narcotics, which can themselves cause oesophageal spasm. Botox may be injected into the muscle of the lower oesophagus to relax the muscle and occasionally, patients undergo surgical division of the oesophageal muscle, a procedure with unpredictable results. For more information about oesophageal spasm see [16].
Acute pain and medical disorders
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
The most common cause of upper gastrointestinal symptoms is non-ulcer dyspepsia (NUD) and yet the pathophysiology of this condition is poorly characterized and the optimum treatment is uncertain. NUD is frequently classified as a functional gastrointestinal disorder; however, dyspepsia may be related to gastroesophageal reflux or gastritis. Patients with functional dyspepsia have higher levels of anxiety, depression, and neuroticism, although there are insufficient data to determine if they respond to psychological therapies.138[I] Esophageal spasm is a related upper gastrointestinal acute pain disorder where increased lower esophageal smooth muscle spasm is associated with dysphagia and epigastric or retrosternal pain, occasionally mimicking acute coronary ischemia.
Formulation development and evaluation of nifedipine as pylorospasm inhibitor
Published in Drug Development and Industrial Pharmacy, 2018
Shaheen Sultana, Sushma Talegaonkar, Bhaskar Ray, Harvinder Singh, F. J. Ahmad, Gaurav Mittal, Aseem Bhatnagar
The role of calcium channel blockers (CCBs) has already been tested for their effects on esophageal spasm. These have been used to relieve esophageal spasm and for opening up gastro-esophageal sphincter for relieving gastric gases, respectively. Nifedipine is used during duodenal endoscopy and endoscopic retrograde cholangiopancreatography (ERCP) procedures if the device is not getting positioned and there is a need for dilatation of the lumen. It is noteworthy that CCBs relax smooth muscles, including those of the lower esophagus sphincter (LES) and esophageal body [11]. The same concept is utilized for treatment of gastroparesis symptoms by developing high-density mucoadhesive formulation which can be targeted to the pylorus, adhered to smooth muscles of pylorus and provides local drug delivery for prolonged period.
Challenges of peroral endoscopic myotomy in the treatment of distal esophageal spasm
Published in Scandinavian Journal of Gastroenterology, 2018
Fraukje Anna-Marie Ponds, André J.P.M. Smout, Paul Fockens, Albert J. Bredenoord
Distal esophageal spasm (DES) is a rare motility disorder associated with dysphagia and chest pain [1,2]. It is characterized by premature and rapidly propagated contractions of the smooth muscle in the distal esophagus. High-resolution manometry (HRM) is the gold standard to diagnose DES reflected by a reduced distal latency (premature contraction) and spastic contractions [3]. Treatment of DES remains challenging because the treatment options are limited, poorly effective or have a transient effect. Here we describe a case of an 84-year old man with DES refractory to conventional therapy who was treated with peroral endoscopic myotomy (POEM). POEM is a promising, effective and permanent treatment for DES, however in this case we highlight some of the difficulties that could arise.
Autoimmune gastrointestinal dysmotility: the interface between clinical immunology and neurogastroenterology
Published in Immunological Medicine, 2021
Shunya Nakane, Akihiro Mukaino, Eikichi Ihara, Yoshihiro Ogawa
Previously, we have observed that Japanese females are predominantly affected by AAG with severe dysmotility [5]. Six of 123 seropositive AAG patients presented with achalasia or diffuse esophageal spasm as severe upper GI dysmotility in this study. The mean age and mean age at disease onset were 49.7 years and 37.8 years, respectively. A gradual mode of onset was more common, and the GI tract symptoms included various digestive system problems, such as appetite loss, nausea and/or vomiting, early satiety, and postprandial abdominal pain owing to the dysfunction of the upper digestive system, and diarrhea, constipation, alternate stool abnormality, and paralytic ileus owing to the dysfunction of the lower digestive system. Among the 123 patients with seropositive AAG, 4 patients had paralytic ileus, one of whom disclosed having gastroparesis as severe lower GI dysmotility. The mean age and mean age at disease onset were 63.5 years and 60.5 years, respectively. A gradual mode of onset was frequently observed and widespread dysfunction of the digestive system was common. Other autonomic symptoms (orthostatic hypotension/intolerance and bladder dysfunction) and extra-autonomic manifestations were observed in these 10 patients. In particular, regarding extra-autonomic manifestations, autoimmune diseases (Sjögren’s syndrome and primary biliary cirrhosis) were detected in 2 patients and gastric cancer was detected in 1 patient. Furthermore, we attempted to clarify the seroprevalence of gAChR AAbs in the patients with severe GI dysmotility in this previous study. We enrolled 28 patients with achalasia and 14 patients with IPO and detected anti-gAChR AAbs in 21.4% patients with achalasia and in 50.0% patients with chronic IPO. Although the patients with achalasia and chronic IPO demonstrated various autonomic dysfunction, bladder dysfunction was observed in the seropositive patients with chronic IPO as a prominent clinical characteristic of dysautonomia. The seropositive IPO group showed female predominance (71%). Two of seven cases of seropositive IPO had Sjögren’s syndrome and cancer of the uterine body. However, in our study, no significant difference was noted in the coexistence of autoimmune diseases and tumors between the seropositive and seronegative IPO groups.