Diffuse Esophageal Spasm

Diffuse esophageal spasm (DES) (also known as distal esophageal spasm) is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation. In some cases, it may cause symptoms such as chest pain, similar to heart disease. In many cases, the cause of DES remains unknown.

Several radiographic findings are suggestive of DES, such as a "corkscrew esophagus" or "rosary bead esophagus" appearance on barium swallow x-ray. Specialized testing called manometry can be performed to evaluate the motor function of the esophagus, which can help identify abnormal patterns of muscle contraction within the esophagus that are suggestive of DES.

Signs and Symptoms

 * chest pain (retrosternal area)
 * intermittent difficulty swallowing solid foods and liquids (dysphagia)
 * esophageal spasms interfere with sleeping routine - insomnia

Diagnostics

 * "corkscrew esophagus" or "rosary bead esophagus" appearance on barium swallow x-ray
 * scintigraphy, manometry

Treatment

 * The treatment of DES consists primarily of medications, such as acid-suppressing agents (like proton-pump inhibitors), calcium channel blockers, hyoscine butylbromide, or nitrates. In only extremely rare cases, surgery may be considered. People with DES have higher incidences of gastroesophageal reflux disease (GERD), neuromuscular diseases, and degenerative neurological disorders. It is thought, however, that many cases are caused by uncontrolled brain signals running to nerve endings. Therefore, suppression medication is often the first-line therapy such as antidepressants and anti-epileptic medication are prescribed. It has also been reported that very cold or hot beverages can trigger an esophageal spasm
 * similar to the treatment used for achalasia

Related articles

 * Dysphagia
 * Achalasia