Question
A 50 year old male presented with complain of chest pain and dysphagia.On Barium swallow,the following picture is seen.What can be the most probable diagnosis?
A. Diffuse Esophageal Spasm.
B. Esophageal Carcinoma.
C. Achalasia Cardia.
D. Esophageal Sphincter.
Show Answer
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Correct Answer » A
Explanation
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Ans:A. Diffuse Esophageal Spasm.
In the barium swallow:Cork screw esophagus or “rosary bead esophagus” is seen,suggestive of Diffuse esophageal spasm.
Diffuse esophageal spasm
- It is a condition characterized by uncoordinated contractions of the esophagus
Pathology
- Aetiology is unknown but may be related to loss of inhibitory neurones in the distal oesophagus.
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)
Radiological features:
Barium Swallow:
- “Corkscrew oesophagus” or “rosary bead oesophagus” where normal peristalsis is interrupted by many tertiary (non-propulsive) contractions occurring in the distal oesophagus.
- Manometry is the gold-standard diagnostic test.
Treatment:
- Drugs like nitroglycerin, hyoscine butylbromide, calcium channel blockers, hydralazine, and anti-anxiety medications.
- Acid suppression therapy, such as proton pump inhibitors.
- Botulinum toxin
- Endoscopic balloon dilation
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