OLFACTORY STIMULI PROVOKE DIFFUSE ESOPHAGEAL SPASM - REVERSAL BY IPRATROPIUM BROMIDE

Diffuse esophageal spasm (DES) is a motor disorder of the esophageal s mooth muscle characterized by multiple spontaneous contractions and by swallow-induced contractions that are of simultaneous onset, large am plitude, long duration, and repetitive occurrence. Although the pathog enesis of DES is unknown, provocative studies with cholinergic stimula tion, esophageal balloon distention, or acid instillation have suggest ed involvement of both sensory and motor mechanisms. This report descr ibes a patient with DES who would predicably become symptomatic with d ysphagia and chest pain upon inhalation of perfume or other strong odo rs. Using esophageal scintigraphy to quantitate and analyze esophageal transit in this patient, we report for the first time that olfactory stimulation triggers episodes of DES and that such phenomena are media ted through the vagus nerve, because they can be ameliorated by the ad ministration of ipratropium bromide. These observations suggest a new (sensory) pathway for the induction of DES and raise the intriguing po ssibility that inhaled anticholinergics may have a therapeutic role in the management of spastic esophageal motility disorders.