diffuse esophageal spasm

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Diffuse Esophageal Spasm



Diffuse esophageal spasm is a term used to define an uncoordinated or spastic esophagus.


The esophagus is a muscular tube that actively transports food from the throat to the stomach by rhythmic contractions known as peristalsis. The actual mechanism and anatomy are quite complex, involving three distinct segments and allowing a person to swallow even when upside-down. Diffuse esophageal spasm describes a condition where the entire esophagus is spastic—along its entire length, the muscular activity is increased and uncoordinated. The name corkscrew esophagus describes perfectly the appearance of this disorder on x rays.
X rays may reveal a slightly different appearance and result in the designation rosary bead esophagus, but the cause is still diffuse spasm, and the two entities behave in the same way.

Causes and symptoms

The cause appears to be disruption of the complex system of nerves that coordinates the muscular activity. The result is difficulty swallowing (dysphagia) and pain that feels like a heart attack and can involve the entire chest, jaw, and arms.


Swallowing problems usually call for esophagograms. In the x-ray department, the patient is given a contrast agent to drink. During swallowing, x rays record the passage of the agent down the esophagus and into the stomach. Instead of a straight tube with well-coordinated waves of contraction, the resulting x rays show a writhing organ resembling a giant corkscrew.
Another test that is used in many disorders of esophageal motility is manometry. Pressures inside the esophagus are measured every inch or so using a balloon device that is passed all the way down to the stomach. The result is a precise record of its activity that yields a specific diagnosis.

Key terms

Contrast agent — A substance that produces shadows on x rays.
Manometry — Measurement of pressure.
Peristalsis — Slow, rhythmic contractions of the muscles in a tubular organ, such as the intestines, that propel the contents along.


Soft and liquid foods pass more easily than solid pieces. Medications of several types are helpful—nifedipine, hydralazine, isoproterenol, and nitrates being the most successful. Several other treatments have uncertain results. For severe cases, relief is obtained two-thirds of the time by cutting the muscles along the entire length of the esophagus. This is a major surgical procedure.


This condition does not go away, nor is treatment entirely satisfactory. Patients need to be careful of what they eat and continue on medication if a beneficial one is found. Fortunately, the condition does not get progressively worse as time passes.



Goyal, Raj K. "Diseases of the Esophagus." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

dif·fuse e·soph·a·ge·al spasm

abnormal contraction of the muscular wall of the esophagus causing pain and dysphagia, often in response to regurgitation of acid gastric contents.
Farlex Partner Medical Dictionary © Farlex 2012
A neurogenic disorder characterised by periodically spaced, high-amplitude spastic peristaltic contractions of the lower oesophagus that occur spontaneously or are evoked by swallowing or gastric acid reflux
Pathogenesis Due to increased responsiveness to neurotransmitters or hormones
Management Antispasmodics, avoidance of cold fluids, dilation, myotomy
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

dif·fuse e·soph·a·ge·al spasm

(di-fyūs ĕ-sofă-jēăl spazm)
Abnormal contraction of muscular wall of the esophagus causing pain and dysphagia, often in response to regurgitation of acid gastric contents.
Medical Dictionary for the Dental Professions © Farlex 2012
References in periodicals archive ?
Paediatric gastroenterology specialist reported that this medical condition was not associated with any primary oesophageal motility disorders (achalasia, diffuse oesophageal spasm, nutcracker oesophagus, etc.) and secondary oesophageal motility disorders (diabetes mellitus, scleroderma, etc.).
Figure 1: The Chicago classification for achalasia subtypes (9) Type I Achalasia with minimal oesophageal (classic) pressurisation Type II Achalasia with oesophageal compression Type III Achalasia with oesophageal spasm Figure 2: Treatment options available for the management of achalasia Pharmacological Oral nitrates (GTN, Isosorbide dinitrate) options Calcium channel blockers (Nifedipine, verapamil) Anticholinergics Opioids (loperamide) Phosphodiesterase inhibitors *2 agonists Nitric oxide agonists Endoscopic Pneumatic balloon dilatation techniques Botulinum toxin injections Peroral endoscopic myotomy (POEM) Surgical Heller's cardiomyotomy (transabdominal or options transthoracic / open or laparoscopic)
Evolving information suggests that high-resolution manometry has superior sensitivity to conventional manometry in recognizing atypical cases of achalasia and distal oesophageal spasm. (A 2/b)
(11) Mid-oesophageal diverticula have been associated with several manometric abnormalities, including nutcracker oesophagus, diffuse oesophageal spasm (DOS), achalasia, hypertensive lower oesophageal sphincter and nonspecific oesophageal motility disorder.
This is called diffuse oesophageal spasm and barium swallow tests can detect it.
GORD is more likely if there are symptoms such as heartburn, acid regurgitation, a bitter taste in the mouth, dysphagia, dysphonia or globus (oesophageal spasm).
SOUNDS like heartburn, or oesophageal spasm, in which the gullet muscles go into cramp.