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Ann Thorac Surg 1974;18:327-336
© 1974 The Society of Thoracic Surgeons

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Articles

Primary Disordered Motor Activity of the Esophagus (Diffuse Spasm): Diagnosis and Treatment

Department of Surgery, University of Toronto Faculty of Medicine, and the Department of Thoracic Surgery, Toronto General Hospital, Toronto, Ont., Canada

^* Address reprint requests to Dr. Henderson, Room 139, University Wing, Toronto General Hospital, Toronto, Ont., Canada

Primary disordered motor activity (PDMA) of the esophagus is characterized by abnormal motor activity in the lower two-thirds of the esophagus. Twenty-one patients with this syndrome were studied by history, roentgenography, endoscopy, manometry, and at operation. The results of a new and more radical approach to esophageal myotomy are evaluated.

Pain, dysphagia, and weight loss are characteristic of PDMA. Motor spasm is seen roentgenographically, the esophageal wall is thickened, and with longstanding disease a retention esophagus develops. Manometry showed a very severe motor disorder in the lower two-thirds of the esophagus. Postoperative manometric studies were of value in distinguishing PDMA from achalasia, as proximal esophageal peristalsis was more recognizable. At operation muscle hyperplasia and spasm were found. A myotomy from the stomach to 10 cm. above the aortic arch was done, and it was found necessary to add a Collis gastroplasty to control reflux. With this approach all patients have had relief of pain and dysphagia.

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