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home - Oesophagus - Oesophageal Dysmotility - DOS and Nutcracker Oesophagus Written by Dr Sebastian Zeki

DOS and Nutcracker Oesophagus

Diffuse esophageal spasm and nutcracker esophagus Classification of primary oesophageal motility abnormalities: Diffuse oesophageal spasm (DES)DOS is diagnosed by 20% or more simultaneous contrac-tions (with amplitude >30 mmHg).1/3rd of patients also have hypertensive or incompletely relaxing LOS.Radiography is variable.Radiography can be normal or show broad spectrum of severe tertiary contractions resulting in "rosary bead" or "corkscrew" oesophagus.Radiography is not sensitive or specific.The pathophysiology may be one of malfunction in endogenous nitric oxide synthesis and/or degradation. Nutcracker oesophagus The average distal oesophageal peristaltic pressures are > 220 mmHg during 10 or more 5 mL liquid swallows. Patients may have hypertensive or incompletely relaxing LOS.This is due to a hypercholingergic state. Hypertensive lower oesophageal sphincter.Resting LOS pressure > 45 mmHg. > 220 mmHg 20% > 45 mmHg DysphagiaChest pain Chest pain Management of patients whose primary symptom is chest painPatients can use calcium channel blocker (ie, diltiazem 180 to 240 mg/day) or a tricyclic antide-pressant (ie, imipramine 25 to 50 mg at bedtime).Reserve botulinum toxin or a nitric oxide contributing drug (ie, a nitrate or phosphodiesterase inhibitor) for patients who do not respond. Management of patients whose primary symptom is dysphagia Best treatment is calcium channel blocker. Written by Dr Sebastian Zeki

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