High-resolution manometry in the diagnosis of diffuse esophageal spasm: A rare motility disorder

Abstract

Background: Diffuse esophageal spasm (DOS) is a rare motility disorder. High-resolution manometry (HRM) is used for the diagnosis of DOS in patients confirmed with non-cardiac chest pain and/or dysphagia. The body of the esophagus and the lower esophageal sphincter (LOS) exhibit various motility characteristics that are typical to DOS. The study was conducted to study the HRM patterns in DOS using a 16-channel water perfusion high-resolution esophageal manometer. Aims and Objectives: The objective of the study was to analyze the various motility patterns in DOS with the help of HRM and also to look for those patients who, at the time of the HRM recording, did not reveal overt patterns of motility that is typical to DOS. Materials and Methods: HRM was performed in 13 adult patients (mean age = 61 years) referred as cases of DOS, out of which three had HRM features of DOS. All patients were subjected to HRM following which the results were analyzed. Results: Ten cases had essentially normal HRM findings. The other three patients had a high basal LOS pressure (BLOSP) and elevated distal wave amplitudes. However, all three cases had a normal LOS relaxation pattern. Manometric features of DOS may not be obvious in all referred cases of DOS, and hence, false-negative results are likely. DOS often has high BLOSP along with very high distal wave amplitudes. However, the LOS relaxation during swallows does not get affected. Although the mean age for DOS is 71 years, yet it can also occur in younger adults. Conclusion: Most of the DOS patients may not manifest manometrically at the time when they are actually undergoing the recording, which leaves a number of cases with a normal HRM finding. Thus, it would not be reasonable to rule out DOS in the absence of HRM confirmation.