Esophageal SpasmWord文档下载推荐.docx

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Treatmentofesophagealspasmsintheshorttermmayinvolveusingmedicationstoquicklyrelaxtheesophagealmuscles.Long-termtreatmentmayinvolvemanaginganycontributinghealthcondition,takingadditionalmedications,alteringyoureatinghabits,andotherapproaches.

Signsandsymptoms

Esophagealspasmsaffectthesmooth（involuntary）musclesinthewallsofyourloweresophagus.Thesespasmsmayoccurintwoforms:

∙Diffusespasms.Thesesimultaneousorirregularcontractionsofesophagealmusclesslowdowntheprogressoffoodtowardyourstomach.

∙Nutcrackeresophagus.Foodmayprogresstoyourstomachnormally,butthecontractionsofyouresophagealmusclesarepainfullystrong.

Forbothformsofesophagealspasms,periodsofcontractionsoftenoccurintermittently,becomingmoresevereoveraperiodofyears.

Signsandsymptomsofesophagealspasmsinclude:

∙Paininyourchest,oftenintense,whichyoumightmistakeforheartpain（angina）

∙Difficultyswallowing（dysphagia）

∙Painfulswallowing

∙Thefeelingthatanobjectisstuckinyourthroat（globus）

∙Bringingfoodbackup（regurgitation）

∙Heartburn,aburningsensationthatmayradiatefromyourupperabdomentoyourneck,sometimesleavingasourtaste

Esophagealspasmscanbedifficulttodiagnosebecauseoftheirsimilaritywithotherdisorders,suchasgastroesophagealrefluxdisease（GERD）,aconditioninwhichstomachacidorbileflowsback（refluxes）intoyouresophagus,irritatingitslining.

Causes

Theexactcauseofesophagealspasmsisunknown.Somepossibilitiesinclude:

∙Extremelyhotorextremelycoldfoods,althoughhowthesefoodsmaytriggerthespasmsisunclear

∙Gastroesophagealdisease（GERD）orheartburn,conditionsaffectingtheesophagusandwhichmaytriggerspasms

Riskfactors

Esophagealspasmsaremorecommoninwomen,andtheincidenceincreaseswithage.Ifyouhavegastroesophagealrefluxdisease,youmaybemorepronetoesophagealspasms.Yourdoctormaytestyouforrefluxortryamedicationtargetedatacidreflux.

Whentoseekmedicaladvice

Ifyouhavedifficultyswallowing,chestpain,frequentheartburnordifficultykeepingfooddown,seeyourdoctor.

Screeninganddiagnosis

Yourdoctormayconfirmadiagnosisofesophagealspasmsbythesemethods:

∙Bariumswallow（esophagram）.Thisisthebestimagingstudytohelpdiagnoseesophagealspasmsandacommontestforpeoplewhohavedifficultyswallowing.AbariumswallowusesaseriesofX-raystoexamineyouresophagus.Duringthetest,you'

lldrinkathickliquid（barium）thattemporarilycoatstheliningofyouresophagussothattheliningshowsupclearlyonX-rayimages.Youmayalsohaveairblownintoyouresophagus,tohelppushthebariumagainsttheesophaguswalls.

Afterthetest,youcaneatnormallyandresumeyourdailyactivities,althoughyou'

llneedtodrinkextrawatertohelpflushthebariumfromyoursystemandpreventconstipation.

∙Esophagealmotility（manometry）test.Inthistest,yourdoctorinsertsathintubethroughyournoseormouthintoyouresophagustomeasuretheeffectivenessofyouresophagealmusclesintheswallowingprocess.

∙Esophagealcomputerizedtomography（CT）scan.CTscansuseanX-ray-generatingdevicethatrotatesaroundyourbodyandapowerfulcomputertocreatecross-sectionalimages,likeslices,oftheinsideofyourbody.Thistestmayshowabnormalthickeningofyouresophagealmuscles,apossibleindicatorofesophagealspasms.

Treatment

Treatmentmayinclude:

∙Managinganyunderlyingconditions.ConditionssuchasheartburnorGERDmaytriggerspasms.

∙Behaviormodification.Yourdoctororadietitianmaysuggestapproachesrangingfromchangingyoureatinghabits（forexample,avoidingmealsbeforebedtime）tochangingyourdiet（avoidingcertainfoods,suchasspicyoracidicfoods）.

∙Biofeedback.Inthismethod,youusethepowerofyourmindtocontrolyourbody.Abiofeedbacktherapistconnectselectricalsensorstoyourbodytohelpyourecognizeandcontrolyourbody'

sphysiologicalresponsetostress.Thistreatmentoptionisavailableinmanyphysicaltherapyclinics,medicalcentersandhospitals.

∙Medications.Smoothmusclerelaxants,suchascalciumchannelblockersornitrates,canreducetheseverityofcontractions.Yourdoctormayalsoprescribetricyclicantidepressants,suchastrazodoneandimipramine,toreducepain.Newertreatments,suchaspeppermintoilandsildenafil,haveshownpromiseinsmallstudies.Inasmallnumberofpeople,directinjectionofbotulinumtoxinalsohasshownsomebenefit.

∙Surgery.Inrarecases,surgerymaybeanoptiontomakeesophagealcontractionsweaker（myotomy）ortoremoveyouresophagusentirely（esophagectomy）.

Prevention

Yourdietmayhaveadramaticeffectonreducingesophagealspasms.Payattentiontowhichfoodsseemtocausethespasms.

Avoidinghot,coldorspicyfoods,largemeals,orfoodswithahighacidcontent（suchasfruitjuice,chocolateandtomatoes）maydecreasetheoccurrenceofspasms.

DiffuseEsophagealSpasm

Theesophagusisamusculartubethatconnectsthemouthtothestomach.Duringswallowing,itcontractsinacoordinatedwaytomovefoodorliquidtothestomach.

Diffuseesophagealspasmcausestheesophagustocontractinanuncoordinatedway.Asaresult,whatisswallowedisnotpusheddownintothestomach.

Symptoms

Between80to90percentofthepeoplewiththisconditionhavechestpain.Thepainoftenstartsorworsenswheneatingordrinkingveryhotfoodsorliquids,anditmayfeelsimilartothepainofaheartattack.

Othersymptomsincludedifficultyswallowingandmorethanhalfofpatientswiththisconditionexperiencethefeelingoffoodgettingstuckinsidethecenterofthechest.Patientsmayalsofeelaburningsensationinthecenterofthechest（heartburn）.

CausesandRiskFactors

Diffuseesophagealspasmscanbecausedbydisruptionsordamagetothenervesthatcoordinatethemusclesoftheesophagus.Insomecases,thisconditioncanleadto

achalasia.

Diagnosis

Thisconditioncanbediagnosedusing:

∙Abariumswallow.X-raystakenoftheesophaguswhilethepatientswallowsbariumshowanuncoordinatedesophagusthatsometimeslookslikeacorkscrew.Uncoordinatedcontractionsmaykeepthebariumfrommovingtothestomach.

∙Esophagealmanometry.Thistestidentifieswhenthemusclesaretightening（contracting）withoutbeingcoordinated.

∙UpperGIendoscopyisalmostalwaysperformedifapatientdescribesfoodstickingintheesophagusafterswallowing.Thisprocessinvolvesputtingaflexibletubewithatinycameradowntheindividual'

sthroatsothatthedoctorcanseeinsidetheesophagus.Thisprocedurecanbehelpdetecttumors,unusualmassesorscars.

Treatmentoptionsinclude:

∙Botulinumtoxin（BoTox®

）.Botulinumtoxinisapoisonproducedbythebacteriathatcausebotulism.DuringupperGIendoscopy,asmallamountofthissubstancecanbeinjectedintothemuscledoesnotrelaxtoblockthefunctionofnervesthatmakethemusclecontract.Thisproceduremayneedtoberepeated.

∙Drugstorelaxthemuscles.Whilemedicationscanhelpsomepatients,theyarenoteffectiveoverall.

∙Peppermintoil.Asmallamountmixedinwatermakesthemusclesoftheesophaguscontractnormallyagain.

∙Surgerytocutthemusclesalongtheloweresophagus.Thisprocedureisusuallyperformedonlyinseriouscasesthatdonotrespondtoothertherapy.

Background:

Broadly,esophagealspasmcanbesubdividedinto2distinctentities:

（1）diffuseesophagealspasm（DES）,inwhichcontractionsareuncoordinated,and

（2）nutcrackeresophagus,inwhichcontractionsproceedinacoordinatedmanner,buttheamplitudeisexcessive.

Symptomscanincludedysphagia,regurgitation,andnoncardiacchestpain.Becauseofthevaguesymptomsanddifficultyindiagnosis,esophagealspasmoftenisnotdiagnosedandisundertreated.Manypatientswithmanometricandradiologicaberrationsmaynothaveanyappreciablesymptoms.

Currently,manometryisthebestdiagnosticmodality.Treatmentincludescalciumchannelblockers,botulinumtoxin,nitrates,tricyclicantidepressants,dilatation,myotomy,andesophagectomy.Researchisongoingtounlocktheunderlyingcausestoimproveourdiagnosticcapabilitiesandtherapeuticregimensinthefuture.

Pathophysiology:

Theesophagusiscomprisedof2layersofmuscle,theinnercircularandtheouterlongitudinallayers.Arbitrarily,theesophaguscanbedividedinto3zones,eachwithseparateyetintegratedanatomyandphysiology.

Esophagealzones

Upperzone:

Comprisedentirelyofstriatedmuscle,thiszoneinitiatesthecontractionsthatpropelthefoodbolusdownth