Diffuse esophageal spasm
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Diffuse/distal oesophageal spasm (DOS) is a motility disorder of the oesophagus. On barium swallow, DOS may appear as a corkscrew or rosary bead oesophagus, but this is uncommon. Manometry is the gold-standard diagnostic test.
Diffuse oesophageal spasm differs from hypercontracting oesophagus ("nutcracker oesophagus").
Epidemiology
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.
Clinical presentation
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.
Pathology
Aetiology is unknown but may be related to loss of inhibitory neurones in the distal oesophagus.
Radiographic features
Fluoroscopy
- only 60% of barium swallows will be abnormal
- <5% will show "corkscrew oesophagus" or "rosary bead oesophagus" where normal peristalsis is interrupted by many tertiary (non-propulsive) contractions occurring in the distal oesophagus
- nonperistaltic contractions, pushing contrast in two directions, can be seen (sometimes the only feature) 5
- sacculations and
pseudodivertuculapseudodiverticula may be seen 5
Differential diagnosis
- achalasia: DOS may mimic achalasia in severe cases
- non-specific oesophageal motility disorder
- secondary oesophageal dysmotility from diabetic autonomic neuropathy
-<li>sacculations and pseudodivertucula may be seen <sup>5</sup>- +<li>sacculations and pseudodiverticula may be seen <sup>5</sup>
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