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June 3, 1983

Long Esophagomyotomy for Esophageal Spasm

Author Affiliations

Case Western Reserve University Cleveland

JAMA. 1983;249(21):2891. doi:10.1001/jama.1983.03330450023013

To the Editor.—  The brief report by Bortolotti et al entitled "Atrial Ventricular Block Induced by Swallowing in a Patient With Diffuse Esophageal Spasm" (1982;248:2297) omitted a valuable therapeutic modality that has been useful in the treatment of the disorder that was described in the text. The association of vagovagal syncope with diffuse esophageal spasm has been previously reported from our institution,1 and we have treated another patient who experienced repetitive syncopal episodes associated with swallowing with a long esophagomyotomy. Since distention of the esophagus, or at least elevated intraluminal pressures, seem to be the primary afferent stimulus, a reduction in the high pressures occurring with esophageal spasm might well be expected to eliminate the syncope.In fact, a long esophagomyotomy rendered our patient totally asymptomatic. A previously reported short myotomy1 failed, but it is well known that a long myotomy from the aortic arch to the gastroesophageal