Diffuse/distal esophageal spasm (DOS) is a motility disorder of the esophagus. On barium swallow, DOS 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").
DOS 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
- nonperistaltic contractions, pushing contrast in two directions, can be seen (sometimes the only feature) 5
- sacculations and pseudodiverticula may be seen 5
- 1. Chaudry MA, Thrumurthy SG, Mughal M. Gastric and Oesophageal Surgery (Oxford Specialist Handbooks in Surgery). Oxford University Press. ISBN:0199663203. Read it at Google Books - Find it at Amazon
- 2. Dheer S, Chang R. Images in clinical medicine. "Corkscrew" esophagus. N. Engl. J. Med. 2003;348 (17): 1671. doi:10.1056/NEJMicm020564 - Pubmed citation
- 3. Richter J. The Lancet. 2001;358 (9284): . doi:10.1016/S0140-6736(01)05973-6
- 4. Eisenberg RL. Gastrointestinal radiology. Lippincott Williams & Wilkins. (2003) ISBN:0781737060. Read it at Google Books - Find it at Amazon
- 5. Paterson. Esophageal motility disorders. GI Motility online (2006) doi:10.1038/gimo20
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