Diffuse Esophageal Spasm (DES)

Diffuse Esophageal Spasm (DES)

Cover image: Oesophagal spasms can feel like sudden, severe chest pain that lasts from a few minutes to hours.

Spontaneous non-peristaltic (uncoordinated) contractions of the oesophagus with normal LES.


  • Diffuse Oesophageal Spasm
    • Peristalsis with normal amplitude but are uncoordinated, simultaneous, or rapidly propagated
  • Hypertensive peristalsis/Nutcracker Oesophagus
    • Peristalsis coordinated but with excessive amplitude
  • Hypercontractile/Jackhammer Oesophagus
    • Contractions of very high amplitude, involving a majority of the oesophagus, and duration for a prolonged period with a jackhammer-type appearance on high-resolution manometry.

Clinical Features

  • Angina-like chest pain (Intermittent, crushing, substernal pain)
    • Radiates to back
  • Dysphagia
  • Regurgitation



  • Diagnosis of choice

Barium esophagogram:

  • Corkscrew appearance

Differential Diagnosis

  • MI (Myocardial infarction)
  • Oesophagitis


  • CCF (Diltiazem): 1st line treatment
  • Nitrates

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