Korean J Gastroenterol.  2012 Aug;60(2):109-112. 10.4166/kjg.2012.60.2.109.

Symptomatic Improvement of Diffuse Esophageal Spasm after Botulinum Toxin Injection

• Han JP
• Hong SJ
• Kim HI
• Byun JM
• Kim HJ
• Ko BM
• Lee JS
• Lee MS

• KMID: 1387339
• DOI: http://doi.org/10.4166/kjg.2012.60.2.109

Abstract

Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up.

Keyword

Diffuse esophageal spasm; Botulinum toxins; Manometry

MeSH Terms

Aged
Anti-Dyskinesia Agents/*therapeutic use
Botulinum Toxins/*therapeutic use
Endoscopy, Digestive System
Esophageal Spasm, Diffuse/radiography/*therapy
Female
Humans
Manometry
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 (A) The initial esophagogram showed repetitive, multifocal, and simultaneous contraction in the esophageal body. (B) Initial esophagoscopy showed much impacted food in the esophageal lumen, which was not dilated fully during the observations. There was no stricture in the esophageal body or at the esophagogastric junction.

• 

  Fig. 2 High-resolution manometry showed rapid contractile front velocity (CFV) attributed to spasm (12 cm/sec) throughout the distal esophageal segments.

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  Fig. 3 (A) The esophagogram 3 months after botulinum toxin injection showed decreased tertiary movement in the distal esophageal segments and smooth passage of barium through the distal esophagus and gastroesophageal junction without stasis. (B) Follow-up esophagoscopy 14 days after botulinum toxin injection showed no food in the esophageal lumen. The esophageal lumen was relatively dilated compared with before treatment.

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