It is important to note that both DES and NE are usually non-progressive disorders that are not associated with more serious medical problems. Treatment should aim at symptomatic relief once heart disease is definitively ruled out through formal examinations. Patients may experience spontaneous improvement or resolution of symptoms in the absence of treatment.
The incidence of psychiatric disorders is increased in patients with spastic esophageal abnormalities. In particular, anxiety, depression and somatoform disorders are more common in this group of patients.
Muscle relaxants such as nitrates, calcium channel blockers, and even botulinum toxin have been used to treat DES and NE, with varying results. Although many small series and anecdotal reports have described a good clinical response to these factors, there are no long-term outcome studies confirming their effectiveness. Side effects (hypotension, headache, etc.) can be serious. Trazodone anxiolytic is the only factor that has been shown to improve the symptoms of esophageal spasticity in a prospective, blinded, controlled study.
Because DES and NE may represent GOP events and GOP treatment has been shown to be beneficial. For these patients, unexplained chest pain has been shown to decrease, regardless of whether the patients had mobility abnormalities.
Endoscopic Myotomy (POEM)
Oral endoscopic myotomy can be applied to treatment-resistant patients. Studies to date have shown encouraging results as the myotomy is performed not only at the level of the lower esophageal sphincter but also in the esophagus itself.
The traditional surgical approach to esophageal spastic disorders was esophageal myotomy. Myotomy performed either laparoscopically or thoracoscopically is mainly intended for patients with DES or NE in whom medical treatment has failed. There are several important points to keep in mind when considering surgical myotomy in patients with DES or NE. First, myotomy will only reduce the intensity of esophageal contractions, not the frequency. Thus, the symptoms may appear even after the surgery. Second, myotomy can lead to a stimulatory esophagus, which can lead to dysphagia (a symptom that surgery is intended to improve). Third, chest pain with DES and NE responds better to myotomy than the dysphagia associated with these diseases.