Medical expert of the article
New publications
Symptomatic diffuse esophageal spasm
Last reviewed: 07.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Symptomatic diffuse esophageal spasm (spastic pseudodiverticulosis, beaded or corkscrew esophagus) is a variant of motility disorders characterized by various non-propulsive and hyperdynamic contractions and increased tone of the lower esophageal sphincter.
Symptoms of diffuse esophageal spasm include chest pain and sometimes dysphagia. Diagnosis is by barium swallow or manometry. Treatment of diffuse esophageal spasm is difficult but includes nitrates, calcium channel blockers, botulinum toxin injections, and antireflux therapy.
Esophageal motility disorders correlate poorly with symptoms; such disorders may cause different symptoms or be asymptomatic in different patient groups. In addition, symptoms and motility disorders are not associated with histopathological changes in the esophagus.
[ Symptoms of diffuse esophageal spasm
Diffuse esophageal spasm usually causes chest pain with dysphagia for solids and liquids. Pain may occur during sleep. Very hot or cold drinks may contribute to increased pain. Over several years, these disorders may progress to achalasia cardia.
Diffuse esophageal spasm can cause severe pain in the absence of dysphagia. This pain is often described as substernal, squeezing, and may be associated with physical exertion. The nature of this pain can be difficult to differentiate from angina.
Some patients have symptoms of diffuse esophageal spasm combined with symptoms of achalasia and diffuse spasm. Some of these combinations have been called active achalasia because they involve both the retention and aspiration of achalasia and the severe pain and spasms of diffuse esophageal spasm.
Where does it hurt?
Diagnosis of diffuse spasm of the esophagus
Diffuse esophageal spasm must be differentiated from coronary ischemia. Absolute diagnosis of esophageal disease based on symptoms is difficult. Barium swallow may show sluggish advancement of contrast and erratic, simultaneous contractions or tertiary contractions. Severe spasms may mimic radiographic findings of a diverticulum, but this may vary in size and location. Esophageal manometry provides the most specific manifestation of spasm. Contractions are usually simultaneous, prolonged, or multiphasic, and may be of very high amplitude (“nutcracker esophagus”). However, spasms may be absent on examination. Increased lower esophageal sphincter (LES) tone or persistent relaxation occurs in 30% of patients. Esophageal scintigraphy and provocative drug tests (eg, edrophonium chloride 10 mg IV) have been of little value.
What do need to examine?
Who to contact?
Treatment of diffuse spasm of the esophagus
Esophageal spasms are often difficult to treat, and controlled studies of treatments are lacking. Anticholinergics, nitroglycerin, and long-acting nitrates have had limited success. Oral calcium channel blockers (eg, verapamil 80 mg 3 times daily, nifedipine 10 mg 3 times daily) may be as effective as botulinum toxin injections into the LES.
As a rule, treatment of diffuse esophageal spasm is limited to drug therapy, but in severe cases it is possible to use pneumatic dilation, bougienage or surgical myotomy along the entire length of the esophagus.