Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry

Figure 1 Barium esophagogram in a patient with distal esophageal spasm showing corkscrew (or rosary beads) appearance of the esophagus, and delayed passage of contrast to the stomach. The corkscrew appearance results from tertiary, non-propulsive contractions of the esophagus circular muscles.

Figure 2 High-resolution manometry of normal swallow and a premature swallow in a patient with distal esophageal spasm. A: High-resolution manometry of normal swallow; B: High-resolution manometry of a premature swallow. CDP: Contractile deceleration point; DL: Distal latency; IRP: Integrated relaxation pressure.

Figure 3 A proposed algorithm for management of diffuse esophageal spasm. CCB: Calcium channel blocker; DES: Distal esophageal spasm; FLIP: Functional lumen imaging probe; HRM: High-resolution manometry; LES: Lower esophageal sphincter; PDE: Phosphodiesterase; POEM: Per oral endoscopic myotomy; PPI: Proton pump inhibitor.