Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 444

These disorders are diagnosed in a minority of patients with dysphagia or chest pain, and in many cases, the relationship between symptoms and motor abnormalities is unclear. Distal oesophageal spasm (formerly termed diffuse) is characterised by the presence of simultaneous or premature pressure waves in the distal oesophagus¹⁸ (Figure 17.4). A barium swallow may show segmentation of contrast by contractions (a corkscrew appearance) in a minority of patients (Figure 17.5) but lacks sensitivity or specificity for diagnosing the disorder. Similar manometric abnormalities may occur in GORD and in association with diabetes mellitus, alcohol abuse, amyloidosis, and progressive systemic sclerosis. Hypercontractile, or ‘jackhammer’ oesophagus, is defined by high‐amplitude oesophageal pressure waves, but peristalsis is maintained and appears normal on the barium swallow. The management of both distal spasm and jackhammer oesophagus is discussed below in relation to non‐cardiac chest pain.