Kor J Neurogastroenterol Motil 2007; 13(1): 76-80  
Case Reports : A Case of Acid Reflux-associated Diffuse Esophageal Spasm aggravated after Acute Pancreatitis
Soo Hoon Eun, M.D., Joon Seong Lee, M.D., Chang Gyun Chun, M.D., Hyun Soo Joo, M.D., Hyun Ku Jung, M.D.,
Kyung Min Kim, M.D., Yeon Soo Kim, M.D., In Seop Jung, M.D., Bong Min Ko, M.D., Su Jin Hong, M.D., Chang Beom Ryu, M.D.,
Jin Oh Kim, M.D., Joo Young Cho, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.
Department of Internal Medicine, Institute for Digestive Research, Soonchunhyang University, College of Medicine, Seoul, Korea
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Diffuse esophageal spasm (DES) is a typical motility disorder of the esophagus thats manifested by episodic chest pain and dysphagia.
Visceral hypersensitivity is considered to be an important pathophysiological mechanism in the development of noncardiac chest pain, the
same as for functional gastrointestinal disorders. Recent studies have revealed that descending facilitation from the rostral ventromedial
medulla maintains visceral pain in a model of experimental pancreatitis. We report here on a 24-year old male who suffered from
retrosternal chest pain and dysphagia, and this was aggravated after acute pancreatitis. The initial endoscopic examination revealed reflux
esophagitis. After 11 months, esophageal manometry showed the typical findings of diffuse esophageal spasm, while the endoscopic
examination and 24 hr pH metry failed to reveal acid reflux. We performed endoscopic botulinum toxin injection that resulted in
relieving his symptoms along with improved results on the balloon provocation test. We present here a case of aggravated
reflux-associated DES after acute pancreatitis, along with a review of the literature.
Keywords: Diffuse esophageal spasm, Acid reflux, Pancreatitis

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