Diffuse esophageal spasm

Last revised by Dr Daniel J Bell on 27 Dec 2019

Diffuse/distal esophageal spasm (DOS) is a motility disorder of the esophagus. On barium swallow, diffuse esophageal spasm may appear as a corkscrew or rosary bead esophagus, but this is uncommon. Manometry is the gold-standard diagnostic test.

Diffuse esophageal spasm differs from hypercontracting esophagus (nutcracker esophagus)

Diffuse esophageal spasm is an unusual cause of non-cardiac chest pain (2%) or dysphagia (4%). It occurs most commonly in patients >50 years old but can occur at any age.  

Chest pain and dysphagia are the primary complaints, but severity and occurrence are highly variable. Regurgitation may also be a feature (but less common than in achalasia) 5.

Etiology is unknown but may be related to loss of inhibitory neurons in the distal esophagus. 

  • only 60% of barium swallows will be abnormal
  • <5% will show "corkscrew esophagus" or "rosary bead esophagus" where normal peristalsis is interrupted by many tertiary (non-propulsive) contractions occurring in the distal esophagus
  • non-peristaltic contractions, pushing contrast in two directions, can be seen (sometimes the only feature) 5
  • sacculations and pseudodiverticula may be seen 5

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Figure 1: corkscrew
    Drag here to reorder.
  • Figure 2
    Drag here to reorder.
  • Case 1
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.