* Signs and symptoms
Esophageal spasm can be divided into two distinct entities: diffuse esophageal spasm in which contractions are uncoordinated and esophagus "Nutcracker" in which contractions are controlled model, but their magnitude is excessive. Esophageal spasm affect people of any age but most often those in the 6th and 7th decade of life.
Diffuse esophageal spasm may be caused by nerve damage or tearing muscles esofageni coordinates. In some cases this leads to destruction of nerve esophageal achalasia cardiei. Esophagus "Nutcracker" is an esophageal motility disorder that causes difficult swallowing or dysphagia for liquids and solids and cause chest pain. It can be asymptomatic. Rarely patients may experience a sudden obstruction of the esophagus after eating food that requires emergency medical intervention. Diseases do not progress to produce the worsening of symptoms or complications from other diseases such as achalasia or esophageal anatomical abnormalities such as peptic stricture or esophageal cancer. Esophagus "Nutcracker" is associated with metabolic syndrome, obesity and gastroesophageal reflux disease.
Manometric Today is the best way to diagnose diffuse spasm. Treatments include administration of calcium blockers, botulinum toxin, nitrates, cyclic antidepressants, dilation, and myotomy esofagotomia. True incidence of esophageal spasm can not be determined accurately. Symptoms range from mild to severe. Patients with mild symptoms usually do not seek medical help. Due to the similarity of symptoms of reflux and esophageal spasm, many patients may be misdiagnosed with reflux.
Mortality is very rare, but morbidity can be significant. Morbidity ranges from impossible food, pain and secondary declinilui nutritional status. The pain can be incapacitating, impiedicaind nosrmala activity and leading to significant physiological changes and impaired quality of life. Chest pain can mimic heart pain, pulmonary, or rheumatologist.
The esophagus is composed of two layers of muscle, one internal and external circular longitudinally. Esophagus can be arbitrarily divided into three zones, each with separate anatomy and physiology.
Esophageal areas. Upper esophagus is composed entirely of striated muscle. This area initaza food bowl contractions that propagate through the esophagus. Upper esophageal sphincter muscle appointed by cricofaringian is located in the upper area. Middle esophagus consists of striated and smooth muscles. Internal circular muscle layer and external longitudinal work in conjunction to propagate the food bowl. Includes lower esophageal sphincter lower esophagus. This sphincter is a thickening of tonic smooth muscle that contracts to prevent reflux of food. In the lower esophageal sphincter resting pressure is 15-25 mm Hg. If food can enter the stomach sphincter relaxes.
Upper esophageal sphincter. When working properly esophagus can detect the presence of a food bolus at the upper esophageal sphincter and will coordinate the progression of food down to the stomach. When these events do not occur normally in coordinated manner the patient may develop symptoms of esophageal spasm. Upper esophageal sphincter is contracted tonic. Manometric evaluation of its top shows a constant activity. As aliemntele reach sphincter muscles contract to move the laryngeal cartilage cricoidian above. Tonic sphincter contraction is inhibited and the opening allows the passage of food. Circular and longitudinal muscles of the upper esophageal area will then propel the food. At the end of the upper area of propulsion initial wave will dissipate and will start a new wave. Solitary nucleus in the brainstem control of the upper esophagus swallowing.
The area middle esophageal food bolus propagation in the upper and the lower. This segment is composed of two internal circular and external longitudinal muscles. Skeletal muscle in this area turns into a smooth or involuntary. Wave travels down the esophagus through coordinated contractions. Longitudinal muscle to contract again before the round. Two strong food travels to the stomach. Gravity is the first and the second is orgnizate muscle contractions. If you perform a myotomy contractions will be ineffective. Only gravity can not bring the bowl to his stomach.
Lower esophageal sphincter is a condensation of smooth muscle. Tonic this muscle is contracted and must relax to allow passage of food. Lack of muscle relaxation is called achalasia.
Diffuse esophageal spasm. Propagation can occur when the waves do not progress correctly. Usually a few segments of the esophagus contract simultaneously, preventing the spread of food. Common presentation is intermittent dysphagia with occasional chest pain. Myotomy is performed only in extreme cases can prevent uncoordinated contractions.
Esophagus "Nutcracker" occurs when the amplitude of contractions exceeding two standard deviations from normal. Contractions start placing food drive organized manner to the stomach. These patients present with dysphagia and chest pain less often than patients with diffuse esophageal spasm. Due to progression of patients do not benefit from normal shrinkage myotomy.
Causes and risk factors.
The etiology of esophageal spasm is unknown. Theories postulates that include: Nursery-release of aceticolinei of unknown cause Gastric reflux disease, or motor nerve -Microvascular compression of the vagus nerve.