Diffuse esophageal spasm

Last revised by Dr Daniel J Bell on 15 Dec 2021

Diffuse/distal esophageal spasm (DOS) is a motility disorder of the esophagus. On barium swallow, diffuse esophageal spasm may appear as a corkscrew 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

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Cases and figures

  • Figure 1: corkscrew
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  • Figure 2
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  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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