Читать книгу The Esophagus - Группа авторов - Страница 195

Patients with diffuse esophageal spasm typically present with recurrent chest pain, dysphagia, or both. Diffuse esophageal spasm is sometimes manifested on barium studies by intermittently absent or weakened primary esophageal peristalsis with simultaneous, lumen‐obliterating, nonperistaltic contractions that compartmentalize the esophagus, producing a classic corkscrew appearance [136] (Figure 6.76A). In a study by Prabhakar et al., however, most patients had nonperistaltic contractions of mild‐to‐moderate severity that did not obliterate the lumen [138], so the absence of a corkscrew esophagus on barium studies in no way excludes this diagnosis. It has also been found that the majority of patients with diffuse esophageal spasm have impaired opening of the lower esophageal sphincter on barium studies with the tapered, beak‐like distal esophageal narrowing classically associated with achalasia [138] (Figure 6.76B). When these patients present with dysphagia, they may have a marked clinical response to treatment with the Clostridium botulinum toxin or endoscopic balloon dilatation [138]. Achalasia and diffuse esophageal spasm therefore may represent opposite ends of a spectrum of related esophageal motility disorders.

Figure 6.75 Secondary achalasia caused by bronchogenic carcinoma. Double‐contrast view shows a mildly dilated esophagus with beak‐like distal narrowing (straight arrows). Unlike the patient with primary achalasia in Figure 6.74, however, the narrowed segment extends 4–5 cm above the gastroesophageal junction. Also note the large mass (curved arrow) abutting the right side of the mediastinum in a patient with bronchogenic carcinoma that had metastasized to the gastroesophageal junction. (Aspirated barium is seen at the right lung base.).

Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.