ESOPHAGEAL SPASM

Question 1

Pertinent Anatomy of a patient with Esophageal spasm

Answer 1

(1) Esophagus
(a) Distal two-thirds
1) Muscularis layer

Question 2

The esophagus functions to promote

Answer 2

motility, via peristalsis, to introduce ingested food to the stomach

Question 3

loss of peristalsis in the distal two-thirds of the

esophagus and impaired relaxation of the LES, could be caused by GERD.

Answer 3

Idiopathic motility disorder

Question 4

Idiopathic motility disorder is thought to be a consequence of _______, leading to premature
and rapidly propagated contractions in the distal esophagus.

Answer 4

Impaired inhibitory innervation

Question 5

Signs and Symptoms

Answer 5

(1) Gradual onset of dysphagia with solid foods and some liquids
(2) Substernal discomfort/ fullness
(3) Lifting neck or throwing shoulders back to enhance gastric emptying
(4) Regurgitation is common

Question 6

Differential Diagnosis

Answer 6

(1) GERD
(2) Peptic Stricture
(3) Pseudo-achalasia

Question 7

Lab

Answer 7

None

Question 8

RAD

Answer 8

(1) CXR
(2) Barium Esophagography
(3) Endoscopy

Question 9

Treatment

Answer 9

(1) Proton Pump Inhibitor (PPI) medications if GERD is present.
(2) Symptom reduction is the goal
(3) Eat smaller bites of food
(4) Invasive procedures (endoscopic injection of botulinum toxin)

Question 10

Initial Care

Answer 10

(1) Treat symptoms associated with spasm.
(2) Check for underlying cause as treatment of cause would eliminate symptoms.
(3) Monitor for improvement.
(4) If oral feeding becomes problematic, refer to parental IV, NPO and prepare patient for MEDEVAC.

Question 11

Complications

Answer 11

(1) Asphyxiation
(2) Dysphagia
(3) Esophageal Dysmotility
(4) Mallory-Weiss Tear
(5) Peptic Stricture