Diagnosis

Endoscopic diagnostic criteria (Fig. 3.54)

► No typical endoscopic findings

► Some cases show segmental, irregular, nonpropulsive contractions leading to asymmetry of the esophagus

► Tenacious deposits and food residues are sometimes found

► The mucosa may appear normal

Differential diagnosis

► Examination artifact

Checklist for endoscopic evaluation

► Observe propulsive and nonpropulsive, synchronous segmental contractions

► Exclude a stenosing process

Fig. 3.53 Diffuse esophageal spasm.

Oral contrast radiograph shows characteristic "corkscrewing" of the lower esophagus. A small pulsion diverticulum (arrow) and hiatal hernia are also present as incidental findings (from: Bur-gener, Röntgenologische Differentialdiagnostik. Stuttgart: Thieme 2000)

Fig. 3.53 Diffuse esophageal spasm.

Oral contrast radiograph shows characteristic "corkscrewing" of the lower esophagus. A small pulsion diverticulum (arrow) and hiatal hernia are also present as incidental findings (from: Bur-gener, Röntgenologische Differentialdiagnostik. Stuttgart: Thieme 2000)

Additional Studies

► Oral contrast study: typical corkscrew or serrated contour during an attack (Fig. 3.53)

► 24-hour manometry: prolonged, synchronous contractions of high amplitude

Comments

Diagnosis is very difficult due to the paroxysmal nature of the complaints. The most rewarding study is manometry. Endos-copy is done to exclude other potential causes of the complaints, particularly malignant lesions.

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