Distal esophageal spasm and gastroesophageal reflux disease: debunking myths and associations

Abstract Background Distal esophageal spasm (DES) is a rare motility disorder presenting with dysphagia or chest pain. Although studies suggest a link between DES and gastroesophageal reflux disease (GERD), data supporting a distinct GERD-related phenotype are limited. Aims This study aims to investigate demographic, symptomatic, and physiologic differences between DES subjects with and without GERD. Methods A retrospective cohort analysis of DES patients determined by high resolution manometry (HRM) was conducted between 2/2020-1/2023. Demographics, medications, symptoms, and quantitative reflux testing data were collected. DES subjects with reflux (R-DES) were defined by presence of Los Angeles Grade B/C/D esophagitis, Barrett’s metaplasia, or abnormal pH testing. DES subjects without reflux (NR-DES) had normal parameters. Statistical analysis employed two-sided or Wilcoxon Rank-Sum, Chi-squared or Fisher’s exact tests, and multivariate logistic regression. Results Of 69 DES subjects, 32 (46.3%) had GERD. R-DES and NR-DES patients had similar demographic variables except for higher BMI in R-DES (30.41 vs 26.88, p = 0.01). R-DES and NR-DES shared similar symptom profiles (heartburn p = 0.67, dysphagia p = 0.448, chest pain p = 0.32). Proton pump inhibitor use was similar between groups (78.1% vs 91.9%, p = 0.202). HRM metrics were comparable except for basal LES tone (20.7 mmHg vs 32.99 mmHg, p = 0.03) and median IRP 11.82 mmHg vs 17.20 mmHg, p = 0.017). Conclusions This study found no distinguishing clinical or physiologic differences between DES patients with and without GERD, challenging the historical emphasis of GERD in DES pathogenesis. The impact of GERD management on the natural history of DES remains uncertain.