Document Detail

Functional aspects of distal oesophageal spasm: the role of onset velocity and contraction amplitude on bolus transit.
MedLine Citation:
PMID:  22475443     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Distal oesophageal spasm is a rare and under-investigated motility abnormality. Recent studies indicate effective bolus transit in varying percentages of distal oesophageal spasm patients.
AIM: Explore functional aspects including contraction onset velocity and contraction amplitude cut-off values for simultaneous contractions to predict complete bolus transit.
METHODS: We re-examined data from 107 impedance-manometry recordings with a diagnosis of distal oesophageal spasm. Receiver operating characteristic analysis was conducted, regarding effects of onset velocity on bolus transit taking into account distal oesophageal amplitude and correcting for intra-individual repeated measures.
RESULTS: Mean area under the receiver operating characteristic curve for saline and viscous swallows were 0.84±0.05 and 0.84±0.04, respectively. Velocity criteria of >30 cm/s when distal oesophageal amplitude>100 mmHg and 8 cm/s when distal oesophageal amplitude<100 mmHg for saline and 32cm/s when distal oesophageal amplitude>100 mmHg and >7 cm/s when distal oesophageal amplitude<100 mmHg for viscous had a sensitivity of 75% and specificity of 80% to identify complete bolus transit. Using these criteria, final diagnosis changed in 44.9% of patients. Abnormal bolus transit was observed in 50.9% of newly diagnosed distal oesophageal spasm patients versus 7.5% of patients classified as normal. Distal oesophageal spasm patients with distal oesophageal amplitude>100 mmHg suffered twice as often from chest pain than those with distal oesophageal amplitude<100 mmHg.
CONCLUSION: The proposed velocity cut-offs for diagnosing distal oesophageal spasm improve the ability to identify patients with spasm and abnormal bolus transit.
Daniel Pohl; Jody Ciolino; Jason Roberts; Edoardo Savarino; Janice Freeman; Paul J Nietert; Radu Tutuian; Donald Castell
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-04-03
Journal Detail:
Title:  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver     Volume:  44     ISSN:  1878-3562     ISO Abbreviation:  Dig Liver Dis     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-05-25     Completed Date:  2012-11-09     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  569-75     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Digestive Disease Center, Division of Gastroenterology and Hepatology, Medical University of South Carolina, USA.
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MeSH Terms
Analysis of Variance
Area Under Curve
Deglutition / physiology*
Esophageal Spasm, Diffuse / diagnosis*,  physiopathology*
Esophageal Sphincter, Lower / physiopathology
Esophagus / physiopathology
Gastrointestinal Transit*
Middle Aged
Muscle Contraction
Plethysmography, Impedance
ROC Curve
Retrospective Studies
Young Adult
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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