Diffuse esophageal spasm (DES) is a rare motility disorder.

1 The term and first clinical

description is attributedn to Osgood, who in 1889 reported six patients suffering from
sudden attacks of constriction in the epigastrium and dysphagia. 2 In 1934, Moersch and
Camp were the first to describe the radiographic appearance based on observations in
eight patients.3 Creamer et al. in 1958 reported the original manometric features as a
pattern characterized by simultaneous contractions (SCs) and prolonged rise of pressure
in the distal esophagus.4 In 1984, Richter and Castell, after studying 95 healthy controls5
and reviewing the existing literature at the time, confirmed that the manometric criteria
of SCs in greater than 10% of wet swallows, but less than 100%, was consistent withDES
and allowed differentiation from achalasia. 6 Most series published after the
implementation of Richter and Castells paper comprise small number of patients; we
found only four studies including more
than 50 patients.710 Furthermore, these series have addressed selected aspects of the
disease. For instance, Dalton et al. in 1991 reported that the prevalence of DES at a
tertiary center was uncommon. Of the 1480 patients referred to esophageal motility, only
4% had
DES. They also underscored that high-amplitude contractions
were uncommon.7 Allen and DiMarino in
1996 evaluated 60 symptomatic patients according to
their SC amplitude, concluding that a diagnosis of
DES should not be made in those with distal contraction
amplitude of less than 30 mm Hg.8 In 2003,
Sperandio et al. found that the SCs that characterize
DES are rarely seen in the proximal esophagus. In
their study, only 3 out of 53 patients (5.6%) had SC in
the proximal esophagus. As a result, they proposed
that the term diffuse esophageal spasm was a misnomer,
and instead it should be relabeled distal esophageal
spasm.9 Tutuian et al. in 2006 focused on the
esophageal bolus transit time using impedancemanometry
in 71 patients. They noted that bolus
transit for liquids and viscous swallows was abnormal
in 25% of the patients and found higher distal esophageal
amplitude (DEA) and higher percentage of complete
bolus transit of liquid swallows in patients with
chest pain compared with patients with dysphagia. 10
The said studies have shed light into selected
aspects of DES. Yet several areas remain insufficiently
understood such as: Are there specific gender
or demographic features in DES? What are the clinical
characteristics of these patients? What is the time
from symptom onset to diagnosis? What is the contribution
of radiology, endoscopy, or ambulatory pH
testing to the diagnosis of these patients? The purpose
of our study is to address these questions in a large
sample of patients at a single tertiary center.