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Diffuse oesophageal spasm and related disorders.

Linsell, Jane Charlotte; (1994) Diffuse oesophageal spasm and related disorders. Masters thesis (M.S), UCL (University College London). Green open access

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Abstract

A significant proportion of patients with non cardiac chest pain and/or dysphagia may have diffuse oesophageal spasm. Conventional techniques of endoscopy and barium studies had a low diagnostic yield for oesophageal motility disorders. Baseline oesophageal manometry using intraoesophageal microtransducers (Gaeltec) diagnosed diffuse oesophageal spasm in 66% of the patients. In view of the intermittent nature of the symptoms, provocative testing during manometry with a Bernstein acid perfusion test and edrophonium injection was used to increase the diagnostic accuracy. The edrophonium provocation test increased diagnostic yield by 34%. Treatment was initially conservative and if this failed then balloon dilatation of the oesophagus was performed. Balloon dilatation relieved symptoms but reduced lower oesophageal sphincter pressure. Success was obtained in the absence of pathological reflux. Dilatation did not result in increased gastro-oesophageal reflux. Many patients with the globus symptom have organic disease accounting for their symptoms. Spasm of the upper oesophageal sphincter secondary to gastro-oesophageal reflux and motility disorders of the oesophageal body have been postulated as causes for the globus sensation. Using the microtransducer system, it was possible to examine the upper oesophageal sphincter with greater accuracy. Patients with the globus symptom as a presenting symptom and normal pan­ endoscopy were investigated with cine-barium, oesophageal manometry and ambulatory pH recording to assess oesophageal motility and reflux. The upper oesophageal sphincter complex was examined but all features, including coordination, were normal. An association between globus and gastro-oesophageal reflux has been demonstrated. No link could be shown between acid perfusion and upper oesophageal sphincter dysfunction. When compared to controls, the globus patients did not have increased psychological abnormality on two psychometry questionnaires. This suggests that the basis for globus may be related to a sensory abnormality in the pharynx in relation to reflux disease.

Type: Thesis (Masters)
Qualification: M.S
Title: Diffuse oesophageal spasm and related disorders.
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10102480
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