Symptomatic diffuse esophageal spasm. Manometric follow-up and response to cholinergic stimulation and cholinesterase inhibition.

Uniform criteria for defining symptomatic diffuse esophageal spasm (SDES) are lacking. Records of patients undergoing esophageal motility studies over a 3-year period were reviewed. Those patients who fulfilled a predefined set of arbitrary criteria for SDES returned for repeat motility study. Manometric abnormalities seen on initial examination remained unchanged on follow-up evaluation. In addition, response in SDES to two pharmacological agents--a cholinergic agonist and cholinesterase inhibitor--was evaluated and compared to that seen in normal subjects and in subjects with heartburn. Patients with SDES responded similarly to both agents, and their responses were significantly greater than those seen in controls or in subjects with heartburn. The results suggest that SDES is a relatively homogenous entity, with respect to both maintaining stability of manometric abnormalities and response to two different pharmacological agents. The future evaluation of similarly defined patients may lead to ascertaining more clearly the underlying pathophysiology of this "syndrome".