Esophageal Motility Disorders,  Esophagus,  Gastroenterology,  Internal Medicine

Diffuse esophageal spasm (DES)

A 32 year old comes to your clinic complaining of difficulty swallowing with solids, as well as both hot and cold liquids. This has been happening intermittently for about a week.


Impaired innervation of the esophagus –> uncoordinated simultaneous contractions (non-peristaltic). This primarily affects the distal esophagus, so this condition is also called Distal Esophageal Spasm (DES).


Spontaneous odynophagia and dysphagia with both solids and liquids. May be described as “chest pain” when eating. Often precipitated by emotional stress. The chest pain is relieved by nitroglycerin and calcium channel blockers — they relax the esophageal myocytes. They often have regurgitation of food.

Key features:

  • – progressive dysphagia to solids & liquids
  • – chest pain or odynophagia
  • – regurgitation of food


Barium swallow (esophogram) will show a “corkscrew” pattern and dilation of the proximal esophagus.

Upper GI endoscopy & barium swallow showing “corckscrew” pattern. — American Journal of Medicine

Manometry will show intermittent peristalsis with many contractions that are not peristaltic.

Manometry results for esophageal motility disorders. — from the journal Nature. Esophageal Motility Disorders by W.G. Paterson, Raj K. Goyal and Fortunée Irene Habib. GI Motility online (2006) doi:10.1038/gimo20

Key features:

  • – Upper GI endoscopy: circular folds in esophagus i.e. “corckscrew” pattern
  • – Barium swallow: constricted, twisted esophageal lumen i.e. “corckscrew”


Calcium channel blockers e.g. diltiazem. Can also use nitrates and tricyclics. May need ballon dilatation. Because patients often have GERD in addition to DES, a trial of PPIs might be helpful.