Diffuse/distal esophageal spasm (DOS) is a motility disorder of the esophagus. On barium swallow, diffuse esophageal spasm 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).
Diffuse esophageal spasm 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) .
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
- non-peristaltic contractions, pushing contrast in two directions, can be seen (sometimes the only feature)
- sacculations and pseudodiverticula may be seen