A patient presented with intermittent chest pain and dysphagia.Barium Swallow examination is shown in the patient.What can be the most possible diagnosis?
A. Esophageal Stricture
B. Esophageal Ring
C. Diffuse Esophageal Spasm
D. Esophageal Carcinoma
Ans:C. Diffuse Esophageal Spasm.
Image shows:the typical “corkscrew” or “beaded” appearance of diffuse esophageal spasms.
Diffuse Esophageal Spasms
- Diffuse esophageal spasms (DES) is a motility disorder characterized by a clinical triad of uncoordinated esophageal contractions, chest pain, and increased intraluminal pressure.
- The chest pain is intermittent, usually substernal, and unrelated to swallowing.
- The pain is often accompanied by dysphagia.
- On manometry, there are repetitive or prolonged-duration contractions, high-amplitude contractions and frequent spontaneous contractions.
- LES function often remains normal though with complete relaxation.
- Primary peristalsis is present in the cervical esophagus, but in the lower two-thirds it becomes absent.
- The contractions become repetitive and simultaneous. The contractions may become so forceful as to obliterate the esophageal lumen and compartmentalize it, therefore producing the typical “corkscrew” or “rosary bead” appearance in contrast studies.