Esophageal spasm
Introduction
Introduction Because of the atrophy of the throat mucosa, if you are eating alcohol or having a bad mood, it is prone to esophageal spasm and cause food to enter the airway for food. Also seen in diffuse esophageal fistula. Diffuse esophageal fistula is a primary esophageal dyskinesia disease characterized by hyperbaric esophageal motility abnormalities. The lesions are mainly in the lower and middle esophagus, which are characterized by high-grade, long-term, non-propelled repetitive contractions. Causes the esophagus to be beaded or spirally narrow, while the upper esophagus and lower esophageal sphincter are often not affected.
Cause
Cause
The main pathological change in the literature is that the lower 2/3 of the esophagus has diffuse muscle hypertrophy. Unlike achalasia, the number of ganglion cells does not decrease. There is no report of central nervous system examination in the literature, so it is not known whether the disease has degeneration of vagus nerve cells similar to achalasia. Some scholars believe that the vagus nerve esophageal branch of this disease is damaged, including nerve filament breakage, collagen increase and mitochondrial rupture. This damage is more diffuse than the damage of achalasia patients.
Examine
an examination
Related inspection
Esophagography esophageal barium meal perspective
Chest pain and intermittent difficulty in swallowing in medical history are suspicious clues. There was no positive finding in the physical examination. Endoscopy is mainly used to rule out other diseases. The diagnosis depends on X-ray examination and pressure test.
1. Pressure test: It shows that non-promoting, uncoordinated contraction and intermittent normal peristalsis occur simultaneously in the esophageal body. The average pressure caused by this uncoordinated contraction can be similar to that caused by normal peristaltic waves, but sometimes it can be significantly increased, and the duration of contraction can be abnormally extended. The upper third of the esophagus is functioning normally, and the pressure of the LES (lower esophageal sphincter) is normal, but it is sometimes increased.
2, methamphetamine test is often negative, but sometimes it can be positive, but can not reach the level of achalasia.
3, X-ray examination of chest radiographs without abnormal findings, esophageal X-ray barium examination showed peristaltic wave only reached the level of aortic arch, 2/3 under the esophagus was replaced by an unusually strong, uncoordinated, non-propelled contraction, thus A series of coaxial stenosis occurs in the esophageal lumen, causing the esophagus to be spiral or beaded. However, the severity of the patient's symptoms is not parallel to the extent and extent of X-ray abnormalities. Even the patient is asymptomatic and is accidentally discovered only when examining other diseases.
4, solid food group esophageal scintigraphy Kjellen et al proposed that this method can be used for esophageal manometry and X-ray examination of normal dysphagia patients. The patient was placed on his back under a gamma camera with a computer, and 4 ml of a solid block of 99 m citrate 75 MBq and 15 ml of water were simultaneously swallowed. The image of the bolus from the level of the cartilage to the stomach was recorded using a plotter connected to the computer. It was abnormal to have a bolus stuck twice in one examination, or a delivery time longer than 9.7 s.
Diagnosis
Differential diagnosis
It should be differentiated from achalasia, diffuse esophageal fistula, gastroesophageal reflux disease and esophageal neurosis. Identification is mainly based on esophageal manometry.
1. Diffuse esophageal fistula: The nutcracker esophagus and diffuse esophageal fistula belong to the primary esophageal dyskinesia disease, and it is reported that this disease is a precursor to diffuse esophageal fistula, and it is difficult to identify it. Benjamin et al (1979) found that the high amplitude contraction of the disease is mostly in the lower esophagus, accompanied by normal primary esophageal peristalsis. The main distinguishing point of diffuse esophageal fistula and nutcracker esophagus.
2, gastroesophageal reflux: gastroesophageal reflux patients can sometimes have abnormal esophageal motility, manifested as pseudo-nutcress esophageal appearance. Achen et al (1993) reported that 40 (10%) patients with non-cardiac chest pain were found to have a walnut-eating esophagus, and a gastroscopic examination confirmed 40 cases of erosive esophagitis in a patient with a walnut-shaped esophagus (2.5%). Twenty patients were monitored for 24h esophageal pH, and 13 (65%) had abnormal amounts of acid reflux. Manometry was performed in 12 patients (30%) with gastroesophageal reflux in patients with nutcracker esophagus. After 8 weeks of active anti-acid treatment with high-dose ranitidine or omeprazole in these 12 patients, the diagnostic characteristics of the nutcracker esophagus disappeared in 7 patients (64%), and 2 patients (33%) had normal esophageal motility. Therefore, it is believed that the abnormal esophageal motility seen in these patients is attributed to gastroesophageal reflux. It is advocated that gastroesophageal reflux disease should be excluded first before treatment of non-cardiac chest pain with antispasmodic agents.
3, achalasia: can also be manifested as difficulty in swallowing, sternal pain and anti-feeding. Esophageal barium angiography showed extreme dilatation, prolongation and distortion of the esophagus, and the lower part of the dilatation was a bird's beak-like stenosis. Esophageal manometry showed no peristaltic waves in the 2/3 segment of the esophagus, and high LES pressure with poor relaxation or complete loss of relaxation. The nutcracker esophagus is characterized by a high amplitude of the esophagus, up to 150-200 mmHg, and a long-term (>60 s) peristaltic contraction, but the esophageal LES function is normal and can be relaxed during meals.
