[Nutricional support in the complex treatment of a patient with esophageal spasm].

In the presented clinical case the theme of the need for an integrated therapeutic intervention has been disclosed, including nutritional support on the various links of the pathogenesis of esophagospasm to the effectiveness of the patient's treatment.

Psychiatric disorders in patients with esophageal disease.

Psychiatric disorders have potentially important roles in the manifestations of esophageal disease. A primary causative role for psychiatric factors in the common motility disorders associated with chest pain (esophageal spasm and the nonspecific motor disorders) remains unproven, but psychiatric disorders appear particularly prevalent in this group. In most other esophageal diseases, psychiatric factors interact through recognized psychophysiologic or behavioral mechanisms to affect the clinical presentation. Recognizing the possible levels of interaction has significant therapeutic implications.

Value of recent psychological symptoms in identifying patients with esophageal contraction abnormalities.

One hundred thirty-six (136) patients referred for manometry were studied to see if a multidimensional psychometric inventory could differentiate those with esophageal contraction abnormalities from subjects with other manometric diagnoses. Contraction abnormalities are manometric findings commonly used to support the diagnosis of esophageal spasm syndrome. Recent psychological symptoms were determined using the Hopkins Symptom Checklist (SCL-90R). Three groups of symptomatic patients were compared: those with contraction abnormalities (n = 86), those with aperistalsis (n = 14), and those with normal peristaltic patterns (n = 36). Subjects with contraction abnormalities appeared mildly and diffusely more psychologically symptomatic than those with aperistalsis, but these findings were not apparent with statistical control of between-group differences in recent pain. Contraction abnormality patients could not be differentiated from those with no manometric abnormality. These findings indicate that short-term emotional distress does not effectively differentiate patients with esophageal symptoms and contraction abnormalities from symptomatic patients with other manometric diagnoses.

Is globus hystericus?

Forty-six patients, 9 male, 37 female, presenting to an ear, nose and throat department with a principal complaint of globus sensation were investigated by radiology, manometry, endoscopy and prolonged ambulatory pH monitoring to exclude a physical basis for their symptoms. Patients also underwent assessment by the Eysenck Personality Inventory (EPI) and General Health Questionnaire (GHQ). The only organic abnormalities detected were an abnormal degree of oesophageal acid exposure (seven patients) and oesophageal spasm (one patient). Female patients were neurotic introverts on EPI testing; males were stable ambiverts. High GHQ scores were present in 13 females (35%) and one male and there was a significant correlation between N scores (in the EPI) and GHQ scores. We propose that globus is a useful, single-symptom model for the study of conversion disorders.