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Diffuse esophageal spasm (DES) is a motility disorder characterized by recurrent episodes of chest pain or dysphagia as well as nonpropulsive (tertiary) contractions on radiographs. [5] Nutcracker esophagus is characterized by high-amplitude peristaltic contractions that are frequently prolonged and cause dysphagia and chest pain. [6]
The diagnosis is generally confirmed by esophageal manometry. [2] DES is present when more than a fifth of swallows results in distal esophageal contractions. [2] NE is present if the average strength of the contractions of the distal esophagus is greater than 180 mmHg but the contraction of the esophagus is otherwise normal.
The minor criterion is the presence of repetitive contractions (meaning two or more) that are greater than six seconds in duration. Castell also noted that the lower esophageal sphincter relaxes normally in nutcracker esophagus, but has an elevated pressure of greater than 40 mm Hg at baseline.
Diffuse esophageal spasm (DES), also known as distal esophageal spasm, is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing or regurgitation. In some cases, it may cause symptoms such as chest pain, similar to heart disease. In many cases, the cause of DES remains unknown.
Schematic of manometry in achalasia showing aperistaltic contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter. Because of its sensitivity, manometry (esophageal motility study) is considered the key test for establishing the diagnosis.
A third type of peristalsis, tertiary peristalsis, is dysfunctional and involves irregular, diffuse, simultaneous contractions. These contractions are suspect in esophageal dysmotility and present on a barium swallow as a " corkscrew esophagus ".
Endoscopic image of a non-cancerous peptic stricture, or narrowing of the esophagus, near the junction with the stomach.This is a complication of chronic gastroesophageal reflux disease, and can be a cause of dysphagia.
Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by increased pressure where the esophagus connects to the stomach at the lower esophageal sphincter.