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Substernal Chest Pain Symptoms. It is located in the middle of the chest and the ribs attach to it. Filed Under: Medical Articles and Infographics. Substernal chest pain: Causes, symptoms, diagnosis, and treatment. However, it's best to treat this condition early; because as the disease progresses, the thyroid can put pressure on other body parts located in the neck and chest, such as the trachea, esophagus, lungs, or heart. (NSTEMI), or unstable angina. The features that physicians rely on to diagnose it are the associated symptoms that accompany substernal chest pain. Julie knows that the retrosternal hematoma can put pressure on the heart if it becomes big enough. The pain usually begins in the chest and travels to other parts of the body, such as the jaws or arms. Many treatment measures can be utilized for heart attacks, such as thrombolytic, blood thinners, aspirin, and nitroglycerine. A medical condition can develop called retrosternal goiter, in which all or part of the thyroid is located behind the sternum. Moreover, other problems are also seen in costochondritis, such as pain in the ribs, difficulty in deep breathing, or coughing. (n.d.). Heart attacks can cause substernal chest pain because the heart is deprived of oxygen, causing chest complications, as noted by Right Diagnosis. A fractured sternum is very painful because of the nature of the injury, and other internal injuries may also be associated with it. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Save my name, email, and website in this browser for the next time I comment. Substernal chest pain is caused by such ailments as pneumonia, anemia, hypertension, heart attack and pulmonary embolism. using current production and quality control standards. The sternum is located in the middle of the chest and the ribs attach to it, creating protection for vital organs. Chest pain comes in many varieties, ranging from a sharp stab to a dull ache. https://www.cdc.gov/nchs/products/databriefs/db43.htm. The patient was a 57-year-old female, who visited our hospital for surgical treatment for a large substernal goiter. Noncardiac Chest Pain. Heart attacks are often treated with angioplasty or a coronary artery bypass graft (CABG) and medications such as: Pericarditis is inflammation of the pericardium, or tissue that surrounds the heart. The 2023 edition of ICD-10-CM R07.2 became effective on October 1, 2022. . Julie instructed her to manage her pain with cold packs to the chest and to use pain medication if needed. Diagnosing & Treating Chest & Stomach Injuries, Solar Plexus Injury: Symptoms & Treatment, Psychological Research & Experimental Design, All Teacher Certification Test Prep Courses, Deep Vein Thrombosis: Theory and Treatment, Deep Vein Thrombosis: Practical Applications, Critical Care Nursing for Skin Conditions, Infections of the Blood & Respiratory System, Critical Care Nursing for the Liver & Kidneys, Thoracic Injury: Symptoms & Severity Score. The features that physicians rely on to diagnose it are the associated symptoms that accompany . 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Pain may radiate to the arms, jaw, and / or back. Aortic Dissection Imaging. 2013 ACCF/AHA Guideline for the Management of HeartFailure. Stoller JK. Substernal chest pain can be symptomized by: Presence of a sour taste in the mouth or a sensation of regurgitation where that the swallowed food reenters the mouth Individual having problems with swallowing Presence of chest tenderness with deep palpation Individual having symptoms of heartburn with a burning sensation behind the breastbone. Devon is keenly aware of trends and new developments in the area of health and wellness. But Julie knows that doesn't mean Amanda is out of the woods yet. thing but used less often. If substernal chest pain is found to be psychogenic in nature, as is the case in those suffering from anxiety and panic attacks, mood relaxers and antidepressants may be prescribed. Some of the diagnostic tests are as under: Electrocardiogram (EKG) Blood Tests Chest X-Ray CT scan. We avoid using tertiary references. Esophagitis is a potentially damaging inflammation of the esophagus. A full workup, including medical history and a physical exam, will be done to rule out potential cardiac causes. Painful respiration is a symptom of an infection or other medical condition. Basurto Ona et al. If cancer is suspected, your doctor will suggest a biopsy. Hypertension, diabetes and high cholesterol are all factors that lead to heart attacks. Retrosternal chest pain, therefore, is a pain that occurs inside the chest. You have 30 days to try one bottle of the product. Pulmonary embolism treatment options. This can compromise the heart's ability to pump blood. Karkhanis V, Joshi J. Pleural effusion: diagnosis, treatment, and management. I would definitely recommend Study.com to my colleagues. newsletter along with exclusive offers from, Bel Marra Health January CT, Wann LS, Alpert JS, et al. American Gastroenterological Association Institute Guideline onInitial Management of Acute Pancreatitis. Treatment often includes OTC medications such as Pepcid but your doctor might prescribe: Retrosternal chest pain can be a symptom of a condition affecting the heart and major blood vessels such as: Angina is chest discomfort triggered by a reduced flow of oxygen-rich blood to the heart. specifications following safe manufacturing practices. In some cases, prescription medication and even surgery are necessary treatments for GERD. It protects the heart and other organs and is compressed during CPR to help pump the heart due to its proximity to the organ. Substernal goiters can cause compressive symptoms and can harbor a thyroid cancer. If the pericarditis is chronic, colchicine (Colcrys) could be prescribed. It can be squeezing or pressure-like. The differential diagnosis is broad and includes cardiac (e.g., acute coronary syndrome, pericarditis), gastrointestinal (e.g., gastritis, peptic ulcer disease), pulmonary (e.g., pulmonary embolism, tension . Computed tomography of the neck and chest . He received aspirin and nitroglycerin from emergency personnel in route. Suggested by: mid-epigastric pain radiating to back, associated with nausea and vomiting, gallstones. Chest pain can be caused by acute pericarditis, perhaps following a viral illness. Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree. Her retrosternal hematoma was small in size and did not compromise her heart. An error occurred trying to load this video. In this condition, chest pain radiates to the back, neck, or shoulders and often worsens when the patient inhales. Atypical chest p Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). Typical chest pains are related to heart complications, and substernal pain falls under this category. Camargo CA, Rachelefsky G, Schatz M. Managing Asthma Exacerbations in the Emergency Department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations. Conditions such as acid reflux can lead to pain and are often confused with a heart problem. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2020 Report). I feel like its a lifeline. https://www.belmarrahealth.com/substernal-chest-pain-causes-symptoms-diagnosis-treatment/, https://www.medicalnewstoday.com/articles/320185, https://www.physio-pedia.com/Sternal_Pain_-_Different_Causes#, https://www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175, https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction, https://www.webmd.com/heartburn-gerd/guide/what-is-acid-reflux-disease, https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940, https://www.medicalnewstoday.com/articles/146619, https://www.epainassist.com/chest-pain/substernal-chest-pain. The following studies can be performed on unstable patients in most emergency settings: The following studies typically require the patient to be stable enough for transfer to a dedicated imaging suite: Esophageal hypermotility disorders [44][45][46][47], Noncardiac chest pain is most commonly caused by gastrointestinal and musculoskeletal disorders. . Myocardial infarction (heart attack). Two possibilities exist: (1) The pain is the manifestation of underlying coronary artery disease, that is, an anginal attack unrelated to the diving environment per se, or (2) the pain is the result of CAGE associated with pulmonary barotrauma. - Causes, Symptoms & Treatment, Degenerative Disc Disease: Causes, Symptoms & Treatment, Working Scholars Bringing Tuition-Free College to the Community. Substernal is a derived term of sternal. There is a wide range of risk factors that can increase a patient's risk of experiencing chest pain. Some associated symptoms include: Retrosternal chest pain treatment relies upon correctly identifying the underlying cause. Schnemann HJ, Cushman M, Burnett AE, et al. When the results were back, he told her she had a fractured sternum and sent her to have a CT scan. of Microbiology in a diagnostic centre in India. beck junior high student death. It usually occurs due to visceral and parietal pleura rubbing over each other but can be due to musculoskeletal or nerve-related pathology. Loffroy R, Favelier S, Pottecher P, et al. Acute Exacerbations of Chronic Obstructive Pulmonary Disease. specifications following safe manufacturing practices. The treatment of substernal chest pain initially relies on the patients cardiac causes and symptoms. Substernal chest pain: Causes, symptoms, diagnosis, and treatment 1 . Antibiotics could be prescribed if the pericarditis is caused by infection. substernal vs retrosternal chest pain. Joint injury symptoms include swelling or mild pain in the upper chest and difficulty in shoulder movement. In many cases this growth can be slow, enlarging over a period of years and gradually pressing on structures such as the esophagus. It is estimated that about 25% of people in the United States experience Substernal chest pain for one reason or another. Please always ask your doctor for personalized diagnosis, evaluation, assessment, treatment and care management plan. The symptoms of a heart attack may include chest pain, shortness of breathing, abnormal fatigue, nausea, or dizziness. In more common causes of retrosternal chest pain, howeversuch as with acid refluxthe use of medications to reduce stomach acid is commonly implemented. The sternum consists of three parts; manubrium, body, and xiphoid process. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. Julie has cared for people with similar injuries before. Some less common causes of noncardiac chest pain include: Muscle or bone problems in the chest, chest wall, or spine (back). Ghadri J-R, Wittstein IS, Prasad A, et al. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Ranasinghe AM, Strong D, Boland B, Bonser RS. Cardiac enzymes such as troponin and CK-MB will typically increase within 3-12 hours after onset of chest pain if the pt is having . Bronchitis may cause severe cough, chest pain, breathing problems, wheezing or sore throat. The other symptoms are dry cough and shortness of breathing. As adjectives the difference between substernal and sternal is that substernal is (anatomy) situated under the sternum while sternal is of, relating to, or near the sternum. Up to 20% of patients have breathing difficulties and pain coughing or sneezing. During his active practice he served as the head of the Dept. Substernal and retrosternal mean the same thing,: its an The pain may be caused by eating or drinking. They will need imaging studies such as an MRI or CT scan to confirm and begin treatment. Rights Reserved. Sometimes if the medications are not effective surgery such as angioplasty or bypass surgery is recommended. [1]. - Causes, Symptoms & Treatment, What is Radiation Therapy? If cancer is detected or the growth puts too much pressure on the trachea, lungs, or blood vessels, surgical removal is typically recommended. Severe or prolonged substernal or precordial chest pain usually indicates myocardial ischemia. It improves if the patient sits upright or leans forward. Julie continues to monitor Amanda closely now that her injuries have been confirmed. Substernal chest pain is commonly described as sharp, agonizing, compressing, and crushing in nature. Sherwood MW, Kristin Newby L. HighSensitivity Troponin Assays: Evidence, Indications, and Reasonable Use. Substernal chest pain might be abrupt or remain mild for several days before becoming severe. To unlock this lesson you must be a Study.com Member. Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Khalaf M, Chowdhary S, Elias PS, Castell D. Distal Esophageal Spasm: A Review. The features that physicians rely on are associated symptoms that often accompany . Ten causes of epigastric pain. You have 30 days to try one bottle of the product. The doctor ordered a chest x-ray for Amanda. Page RL, Joglar JA, Caldwell MA, et al. In most cases, retrosternal chest pain falls into four primary areas: Retrosternal chest pain can be a symptom of many conditions affecting the upper stomach and esophagus. Due to the relative location of substernal pain, it is often confused with a variety of different medical conditions, which can induce unnecessary anxiety in sufferers. Yancy CW, Jessup M, Bozkurt B, et al. Devon Andre has been involved in the health and dietary supplement industry for a number of years. Yancy CW, Jessup M, Bozkurt B, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. - Causes, Symptoms & Treatment, What Is Gingivitis? Angina is a symptom of coronary artery disease. Substernal and retrosternal mean the same thing,: its an adjective describing the anatomical area below, beneath or behind the breast bone. Learn, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Khan AN, Cho KJ. Although it's likely that pain behind the breastbone relates to the organs located there, such as the heart and esophagus, sometimes the pain originates elsewhere but is felt in this area. Recommendations for the Management of Herpes Zoster. If the retrosternal hematoma is large enough, it can compress the heart. These pains are usually treated with medications but the medications are selected depending on the cause of the pain. Required fields are marked *. All rights reserved. Rights Reserved. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. . Save my name, email, and website in this browser for the next time I comment. As a member, you'll also get unlimited access to over 88,000 3. Additionally, cognitive behavioral and psychological therapy may also be implemented. This space normally measures less than 2.5 cm in width. Precordial pain. A bad . He embraces an active lifestyle combining diet, exercise and healthy choices. Copyright 2023 Bel Marra Health. Symptoms of a fractured sternum include: Sudden onset of pain at the front of the chest after an impact or fall of some kind. Collarbone trauma like swelling or bruising, Mild pain and swelling in the upper chest. Chest retractions can happen at any age if something's blocking your windpipe. newsletter along with exclusive offers from, Bel Marra Health Devon has written extensively for Bel Marra Health. Non-cardiac chest pain (retrosternal, pseudoanginous) is defined as a constricting sensation localized in the middle of the breastbone (sternum), which is not caused by ischemic heart disease or other cardiac pathology. Costochondritis can also occur due to injury, infection, severe coughing, physical strains, or trauma. She's TESOL certified and a National Geographic Certified Educator. Mazuski JE, Tessier JM, May AK, et al. The ingredients are tested by the manufacturer for. Amsterdam EA, Wenger NK, Brindis RG, et al.. 2014 AHA/ACC Guideline for the Management of Patients With NonST-Elevation Acute Coronary Syndromes. If an individual experiences pain just below the sternal bone, then it is termed as Substernal Chest Pain.Substernal Chest Pain can be quite painful and there are various factors which lead to Substernal Chest Pain, some of which can be extremely serious to include Pulmonary Embolism, Aortic Stenosis, Stable Angina Pectoris, Acute Coronary Syndrome, Myocardial Infarction, Atrial Fibrillation . Psychological problems, including pain disorders, stress, anxiety and depression. Supportive management, including pain control and avoiding heavy lifting, pushing, or pulling, is usually all that is needed to allow the sternum to fully heal. Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. What Happens When the Wind is Knocked Out of You? Snyder MJ, Bepko J, White M. Acute pericarditis: diagnosis and management.. Adler Y, Charron P, Imazio M, et al. Surgical intervention could be required to remove the hematoma to relieve the pressure off of the heart and restore circulation. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); We provide cardiology services in Chicago suburbs with offices in Park Ridge, Oak Brook, Niles and Schaumburg. This can be life-threatening and would require emergency intervention. These sound waves can create real-time images of the blood vessels and heart muscles. copyright 2003-2023 Study.com. If an individual experiences pain just below the sternal bone, then it is termed as Substernal Chest Pain. This bone may also be referred to as the breastbone. A retrosternal hematoma occurs when the fractured sternum oozes blood that collects in the back of the sternum and is a complication that can occur with a sternum fracture. Cancer in the mediastinum tissue or bronchus can also be appreciated as retrosternal chest pain. These words are synonymous in the medical world. Angina (an-JIE-nuh or AN-juh-nuh) is a type of chest pain caused by reduced blood flow to the heart. 2013 ACCF/AHA Guideline for the Management ofHeartFailure: Executive Summary. Substernal chest pain is commonly described as sharp, agonizing, compressing, and crushing in nature. However, using your better judgment and recognizing that your particular cause is not normal will be the first step in recovery. A 41-year-old woman presents with fever and retrosternal chest pain of 28 hours duration. Sternum pain is usually caused by problems with the muscles and bones near the sternum and not the sternum itself. Expiration: Both ventricular and atrial septa move sharply to the right. Create your account, 26 chapters | Typical treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs). Discuss substernal vs. retrosternal, retrosternal chest pain, and retrosternal thyroid surgery. With the help of a medical professional, you can find the reasons behind your particular case of substernal pain, helping you address potential harmful medical conditions as soon as possible. They want to rule out the most pressing issues first, like those involving vital organs. Gyawali CP, Fass R. Management of Gastroesophageal Reflux Disease. Your email address will not be published. A doctor prescribes medicines to stop clot formation in arteries. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo Cardiomyopathy. A sternum fracture takes much longer to fully heal and can take up to six months to heal. Your email address will not be published. Chest pain is a prime indication of a heart attack, but sufferers do not always exhibit this type of pain. Blunt force trauma to the chest can cause a sternum fracture, which most often occurs in a motor vehicle accident. Your email address will not be published. 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It is comprised of three parts; the manubrium, the body, and the xiphoid process. What is the difference between retrosternal pain and sub sternal pain. A sternum fracture is a break in the sternum, and fortunately it is not a common injury. Pancreatitis (often due to gallstone impacted in common bile duct). The choice of initial modality is usually based on the patient's clinical status, the pretest probability of the underlying etiology, and resource availability. Chest pain can be divided into cardiac vs non-cardiac origin. Acid reflux and bacterial infection of the stomach (like Helicobacter pylori) can cause this damage. Viruses commonly cause acute bronchitis, while smoking may cause chronic bronchitis. [1] Up to 10% of substernal goiters are located in the posterior mediastinum, and 90% of . - Definition, Types & Side Effects, What Is Sarcoma? Retrosternal chest pain, therefore, is a pain that occurs inside the chest. INTRODUCTION. Around 20% of western countries have been affected by acid reflux, which is most common in women. Patients with acute thoracic aortic dissection may present with chest or back pain. Usually, they will grow within the neck as shown in the picture of the woman on our goiter page. R07.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Chest pain is a warning to seek medical attention. Consider ordering the following studies concurrently with routine studies based on clinical assessment and pretest probability: Imaging is often required to confirm the diagnosis and rule out differential diagnoses. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. Pain there can indicate numerous Copyright 2023 Bel Marra Health. pancreatitis, or inflammation of the pancreas. 2005-2023 Healthline Media a Red Ventures Company. GERD is a more severe and chronic form of acid reflux and is treated the same way. Cardiac problems: By far the most worrisome complication that medical professionals want to rule out first. Substernal goiter may involve one or both the lobes of the thyroid gland and may cause deviation and/or compression of the trachea, and less commonly esophagus or venous structures. A normal level of troponin T or troponin I between six and 72 hours after the onset of chest pain is strong evidence against MI and acute coronary syndrome, particularly if the ECG is normal or . Free Special Report: The Secret Fixes for Your Sleep Problems, Get this report FREE when you opt in for our FREE Health eTalk daily Best Answer. Moreover, sternum is the flat bone at the front of the chest that connects the ribs with the cartilage. Perhaps the most pressing determination is whether chest pain is due to acute cardiac ischemia or to nonischemic cardiovascular or noncardiac causes. Crockett et al. Tracheal compression has been reported in 35% to 73% of substernal goiters. On EKG there will be evidence of ST elevation or depression, Q waves, or inverted T waves. [50], See also Differential diagnosis of increased troponin and Differential diagnosis of ST elevations on ECG.. R07.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. A 52-year-old man presents to the Emergency Department via ambulance with substernal chest pain. Angina pain is often described as squeezing, pressure, heaviness, tightness or pain in the chest. Jun 09, 2022. substernal vs retrosternal chest pain . Generally, a retrosternal hematoma will resolve on its own in two to nine weeks. Medical treatments include the prescription of followings: Artery Relaxing Medications Cardiac Related Medications Medications to Dissolve Clots Blood Thinners Acid-suppressants Antidepressants On the other hand Substernal chest pain can be treated surgically by following methods: Balloons and stent placement Bypass surgery Dissection Lung reinflation. Not all cases are serious enough to warrant immediate medical attention, however, others do. A loud friction rub is appreciated over the left sternal border. Most substernal goiters can be managed through the transcervical approach, but a sternotomy is required in some cases. Bel Marra products are produced Kearon C, Akl EA, Ornelas J, et al. However, some patients experience angina in the absence of physical exertion or emotional stress, and not all chest pain that begins after exertion is angina. Due to the relative location of retrosternal pain, it is often confused with various cardiac conditions that can induce unnecessary anxiety in suffers. These pains can be cured with different medicines such as: Your email address will not be published. the widow's son in the windshield continuation. Classic angina presents with substernal chest pain that's described as "squeezing" or "pressure-like." It often radiates to the arms or jaw and is made worse by exertion or emotion and . Some chest pain is described as crushing or burning. A young lady had a head on collision, luckily at a low rate of speed. Diagnosis and Treatment of Peptic Ulcer Disease. A retrosternal goiter often causes no symptoms for years. lessons in math, English, science, history, and more. Linder H. (2018). Non-cardiac chest pain (NCCP) is chest pain in patients who do not have heart disease. It is chest pain that is mainly caused by the inflammation of the cartilage that connects ribs to the sternum. Chest pain of any nature prompts medical professionals to think of cardiogenic issues first. These goiters can push and displace the breathing tube, swallowing tube and important blood vessels in the neck . T= 100.2 F; HR = 108. Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. If untreated, it could cause death. A retrosternal hematoma occurs when clotted blood pools behind the sternum near the heart. March 3, 2022 by which of the vamps should you date Patients often describe angina pectoris as pressure, tightness, or heaviness located centrally in the chest, and sometimes as strangling, constricting, or burning. Usually, the mass can be removed from the neck; but if it's too large, the surgeon will be forced to open the chest to remove the mass. Infrasternal is another term meaning . These all are the symptoms of respiratory disease that causes substernal pain throughout normal breathing. Roman S, Kahrilas PJ. Typical treatment for pulmonary embolism includes anticoagulation medication like: Often referred to as AFib, atrial fibrillation is an irregular heart rate that can heighten your risk of stroke and heart disease. 1 . People with sternum fractures may face difficulty breathing and swelling in the sternum. Read the, immediately life-threatening causes of chest pain, Acute management checklist for aortic dissection, Acute management checklist for cardiac tamponade, Acute management checklist for acute pericarditis, Acute management checklist for heart failure exacerbation, Acute management checklist for Takotsubo cardiomyopathy, Acute management checklist for thoracic aortic aneurysm, Acute management checklist for pulmonary embolism, Acute management checklist for tension pneumothorax, Acute management checklist for spontaneous pneumothorax, Acute management checklist for asthma exacerbation, Acute management checklist for COPD exacerbation, Acute management checklist for pleural effusion, Acute management checklist for esophageal perforation, Acute management checklist for acute pancreatitis, Acute management checklist for esophageal hypermotility disorders, Acute management checklist for Mallory-Weiss syndrome, acute management checklist for herpes zoster, Rome IV criteria for functional chest pain, Differential diagnosis of increased troponin, Differential diagnosis of ST elevations on ECG, https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/diffuse-esophageal-spasm.