Diffuse esophageal spasm

Diffuse/distal esophageal spasm (DOS) is a motility disorder of the esophagus. On barium swallow, DOS may appear as a corkscrew or rosary bead esophagus, but this is uncommon. Manometry is the gold-standard diagnostic test. 

Diffuse esophageal spasm differs from hypercontracting esophagus ("nutcracker esophagus"). 

DOS is an unusual cause of non-cardiac chest pain (2%) or dysphagia (4%). It occurs most commonly in patients >50 years old but can occur at any age.  

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) 5.

Etiology is unknown but may be related to loss of inhibitory neurons in the distal esophagus

  • only 60% of barium swallows will be abnormal
  • <5% will show "corkscrew esophagus" or "rosary bead esophagus" where normal peristalsis is interrupted by many tertiary (non-propulsive) contractions occurring in the distal esophagus
  • nonperistaltic contractions, pushing contrast in two directions, can be seen (sometimes the only feature) 5
  • sacculations and pseudodiverticula may be seen 5
Oesophageal pathology
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Article information

rID: 32647
Synonyms or Alternate Spellings:
  • Corkscrew esophagus
  • Rosary bead oesophagus
  • Diffuse esophageal spasm
  • Corkscrew oesophagus
  • Distal oesophageal spasm
  • Distal esophageal spasm
  • Rosary bead esophagus

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Cases and figures

  • Figure 1: corkscrew
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  • Figure 2
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  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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