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Systematic review and meta-analysis on the treatment of diffuse esophageal spasm

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Summary

Background

Diffuse esophageal spasm is a rare motility disorder and although diagnosis has improved over the years, optimal treatment remains controversial. The aim of this study was to determine the success rates of alternative treatments for diffuse esophageal spasm.

Methods

MEDLINE, EMBASE, and the Cochrane Library were searched for studies which reported treatment outcomes in patients with diffuse esophageal spasm. The primary outcome measure was success rate. Secondary outcome measures were morbidity and mortality.

Results

Ten observational studies involving 101 patients (35 male, 66 female, median age 61 years) with diffuse esophageal spasm treated with nifedipine (n = 24), botulinum toxin (n = 41), and surgery (n = 46) were analyzed. At a median follow-up of 8 months, the overall success rates for nifedipine, botulinum toxin, and surgery were 42.74% (95% c. i. [42.68–42.79], p < 0.00001), 74.39% (95% c. i. [74.27–74.52], p < 0.00001), and 95.74% (95% c. i. [95.69–95.80], p < 0.00001), respectively. Morbidity after surgery was 2% and no operative deaths were reported.

Conclusion

Surgery appears to be safe and the most successful treatment. The less invasive medical and botulinum toxin therapies provide short-term symptom relief.

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References

  1. Storr M, Allescher HD, Classen M. Current concepts on pathophysiology, diagnosis and treatment of diffuse oesophageal spasm. Drugs. 2001;61(5):579–91.

    Article  CAS  PubMed  Google Scholar 

  2. Richter JE. Oesophageal motility disorders. Lancet. 2001;358(9284):823–8. https://doi.org/10.1016/S0140-6736(01)05973-6.

    Article  CAS  PubMed  Google Scholar 

  3. Almansa C, Heckman MG, DeVault KR, Bouras E, Achem SR. Esophageal spasm: demographic, clinical, radiographic, and manometric features in 108 patients. Dis Esophagus. 2012;25(3):214–21. https://doi.org/10.1111/j.1442-2050.2011.01258.x.

    Article  CAS  PubMed  Google Scholar 

  4. Bodger K, Trudgill NJ. Guidelines for oesophageal manometry and pH monitoring. In: BSG guidelines in gastroenterology. 2006. pp. 1–12.

    Google Scholar 

  5. Anonymous. Managing diffuse oesophageal spasm. Drug & Therapeutics Bulletin. 2011;49(5):54–7; quiz i–ii. https://doi.org/10.1136/dtb.2011.02.0030.

  6. Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut. 2001;49(1):145–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74. https://doi.org/10.1111/nmo.12477.

    Article  CAS  PubMed  Google Scholar 

  8. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(Suppl 1):57–65. https://doi.org/10.1111/j.1365-2982.2011.01834.x.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Roman S, Kahrilas PJ. Distal esophageal spasm. Dysphagia. 2012;27(1):115–23. https://doi.org/10.1007/s00455-011-9388-3.

    Article  PubMed  Google Scholar 

  10. Grubel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol. 2008;103(2):450–7. https://doi.org/10.1111/j.1572-0241.2007.01632.x.

    Article  PubMed  Google Scholar 

  11. Eypasch EP, DeMeester TR, Klingman RR, Stein HJ. Physiologic assessment and surgical management of diffuse esophageal spasm. J Thorac Cardiovasc Surg. 1992;104(4):859–68. discussion 68–9.

    CAS  PubMed  Google Scholar 

  12. Khashab M, Messallam AA, Onimaru M, Teitelbaum EN, Ujiki MB, Gitelis ME, et al. International multicenter experience with peroral endoscopic myotomy (POEM) for the treatment of spastic esophageal disorders refractory to medical therapy. Gastrointest Endosc. 2014;1:AB167.

    Article  Google Scholar 

  13. Leconte M, Douard R, Gaudric M, Dumontier I, Chaussade S, Dousset B. Functional results after extended myotomy for diffuse oesophageal spasm. Br J Surg. 2007;94(9):1113–8. https://doi.org/10.1002/bjs.5761.

    Article  CAS  PubMed  Google Scholar 

  14. Miller LS, Pullela SV, Parkman HP, Schiano TD, Cassidy MJ, Cohen S, et al. Treatment of chest pain in patients with noncardiac, nonreflux, nonachalasia spastic esophageal motor disorders using botulinum toxin injection into the gastroesophageal junction. Am J Gastroenterol. 2002;97(7):1640–6. https://doi.org/10.1016/S0002-9270%2802%2904177-1.

    Article  PubMed  Google Scholar 

  15. Storr M, Allescher HD, Rosch T, Born P, Weigert N, Classen M. Treatment of symptomatic diffuse esophageal spasm by endoscopic injection of botulinum toxin: a prospective study with long term follow-up. Gastrointest Endosc. 2001;54(6):18A.

    Article  CAS  PubMed  Google Scholar 

  16. Vanuytsel T, Bisschops R, Farre R, Pauwels A, Holvoet L, Arts J, et al. Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11(9):1115–1121.e2. https://doi.org/10.1016/j.cgh.2013.03.021.

    Article  CAS  PubMed  Google Scholar 

  17. Blackwell JN, Holt S, Heading RC. Effect of nifedipine on oesophageal motility and gastric emptying. Digestion. 1981;21(1):50–6.

    Article  CAS  PubMed  Google Scholar 

  18. Davies HA, Lewis MJ, Henderson AH. Trial of nifedipine for prevention of oesophageal spasm. Digestion. 1987;36(2):81–3.

    Article  CAS  PubMed  Google Scholar 

  19. Nasrallah SM, Tommaso CL, Singleton RT, Backhaus EA. Primary esophageal motor disorders: clinical response to nifedipine. South Med J. 1985;78(3):312–5.

    Article  CAS  PubMed  Google Scholar 

  20. Thomas E, Witt P, Willis M, Morse J. Nifedipine therapy for diffuse esophageal spasm. South Med J. 1986;79(7):847–9.

    Article  CAS  PubMed  Google Scholar 

  21. Patti MG, Pellegrini CA, Arcerito M, Tong J, Mulvihill SJ, Way LW. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders. Arch Surg. 1995;130(6):609–15. discussion 15–6.

    Article  CAS  PubMed  Google Scholar 

  22. Salvador R, Costantini M, Rizzetto C, Zaninotto G. Diffuse esophageal spasm: the surgical approach. Dis Esophagus. 2012;25(4):311–8. https://doi.org/10.1111/j.1442-2050.2010.01172.x.

    Article  CAS  PubMed  Google Scholar 

  23. Khan MA, Kumbhari V, Ngamruengphong S, Ismail A, Chen YI, Chavez YH, et al. Is POEM the answer for the management of spastic esophageal disorders? A systematic review and meta-analysis. Gastrointest Endosc. 2016;1:AB590–AB1.

    Article  Google Scholar 

  24. Sharata AM, Dunst CM, Pescarus R, Shlomovitz E, Wille AJ, Reavis KM, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg. 2015;19(1):161–70. discussion 70.

    Article  PubMed  Google Scholar 

  25. Minami H, Isomoto H, Yamaguchi N, Ohnita K, Takeshima F, Inoue H, et al. Peroral endoscopic myotomy (POEM) for diffuse esophageal spasm. Endoscopy. 2014;46(Suppl 1 UCTN):E79–E81.

    PubMed  Google Scholar 

  26. Shiwaku H, Inoue H, Beppu R, Nakashima R, Minami H, Shiroshita T, et al. Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy. Gastrointest Endosc. 2013;77(1):149–50. https://doi.org/10.1016/j.gie.2012.02.008.

    Article  PubMed  Google Scholar 

  27. Louis H, Covas A, Coppens E, Deviere J. Distal esophageal spasm treated by peroral endoscopic myotomy. Am J Gastroenterol. 2012;107(12):1926–7. https://doi.org/10.1038/ajg.2012.317.

    Article  PubMed  Google Scholar 

  28. Stavropoulos SN, Modayil RJ, Friedel D, Savides T. The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc. 2013;27(9):3322–38.

    Article  PubMed  Google Scholar 

  29. Miller LS, Parkman HP, Schiano TD, Cassidy MJ, Ter RB, Dabezies MA, et al. Treatment of symptomatic nonachalasia esophageal motor disorders with botulinum toxin injection at the lower esophageal sphincter. Dig Dis Sci. 1996;41(10):2025–31.

    Article  CAS  PubMed  Google Scholar 

  30. Han JP, Hong SJ, Kim HI, Byun JM, Kim HJ, Ko BM, et al. Symptomatic improvement of diffuse esophageal spasm after botulinum toxin injection. Korean J Gastroenterol. 2012;60(2):109–12.

    Article  PubMed  Google Scholar 

  31. Bashashati M, Andrews C, Ghosh S, Storr M. Botulinum toxin in the treatment of diffuse esophageal spasm. Dis Esophagus. 2010;23(7):554–60. https://doi.org/10.1111/j.1442-2050.2010.01065.x.

    Article  CAS  PubMed  Google Scholar 

  32. Drenth JPH, Bos LP, Engels LGJB. Efficacy of diltiazem in the treatment of diffuse oesophageal spasm. Aliment Pharmacol Ther. 1990;4(4):411–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiff University, Heath Park, CF14 4XN, Cardiff, Wales, UK

    Harry Vercoe

  2. University Hospital of Wales, Heath Park, CF14 4XN, Cardiff, Wales, UK

    Mubashir Mulla MD, Wyn G. Lewis FRCS, Antonio Foliaki FRCS & David S. Y. Chan FRCS

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Correspondence to David S. Y. Chan FRCS.

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All authors contributed to the conception or design of the work and/or the acquisition, analysis, and interpretation of data. Drafts were revised critically for important intellectual content and the final version approved by all. All agree to be accountable for all aspects of the work.

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H. Vercoe, M. Mulla, W.G. Lewis, A. Foliaki, and D.S.Y. Chan declare that they have no competing interests.

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Vercoe, H., Mulla, M., Lewis, W.G. et al. Systematic review and meta-analysis on the treatment of diffuse esophageal spasm. Eur Surg 51, 239–245 (2019). https://doi.org/10.1007/s10353-019-0574-0

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