Diffuse Esophageal Spasm

Intermittent dysphagia had bothered a 75-year-old woman for 6 months. She said that she felt an obstruction in her lower chest. Recent weight loss was attributed to the inability to swallow.

A barium swallow study revealed the tortuous appearance of the esophagus. The abnormal waves of peristalsis throughout the esophagus-with a characteristic “corkscrew” configuration-are caused by segmentation of the esophageal lumen. Dr Virendra Parikh of Fort Wayne, Ind, diagnosed diffuse esophageal spasm.

Spasm of the esophagus is caused by uncoordinated esophageal contractions that may result in dysphagia and noncardiac chest pain. Often, this disorder responds to sublingual nitrates, making it difficult to distinguish esophageal spasm from angina. Although the peristaltic events that characterize diffuse esophageal spasm are demonstrated in barium swallow studies, esophageal manometry is required for diagnosis.

Smooth muscle relaxants, including nitrates, anticholinergics, and calcium channel blockers, reduce esophageal pressure and offer symptomatic relief. A calcium channel blocker eased this patient's symptoms.