Diffuse Esophageal Spasm with Case

00:01 We'll move on to our next case.

00:02 We have a 48-year-old woman who presents to the emergency department complaining of sudden intermittent episodes of severe chest pain.

00:10 She also notes difficulty with swallowing both liquids and solids when these episodes occur.

00:15 She has no known medical conditions and no family history of cardiac disease. Her vitals are normal.

00:22 On exam, oropharynx and cardiac exam are also normal.

00:25 So what is the best test to confirm the diagnosis? So let's point out some key features of this case.

00:33 She has sudden onset chest pain that may mimic cardiac angina.

00:38 In addition, she has difficulty swallowing both solids and liquids.

00:43 So let's talk a bit about this diagnosis of diffuse esophageal spasm.

00:50 This is a hypertonic motility disorder where the esophagus just contracts too much.

00:55 They may present with chest pain that mimics cardiac angina and they have dysphagia to both liquids and solids during these episodes.

01:04 To diagnose this you may do have barium swallow study which may show the typical appearance of a corkscrew esophagus.

01:12 However, the diagnosis is best made by esophageal manometry which will show these high-amplitude contractions throughout the esophagus.

01:21 Here you can see a normal esophageal manometry test where contraction occurs along the length of the esophagus with peristalsis.

01:29 Here, this is a manometry showing a hypercontractile esophagus.

01:34 So a patient who has esophageal spasm may have too much contraction along the length of the esophagus as shown here.

01:43 The treatment is done with symptomatic relief.

01:46 You may give calcium channel blockers or botulinum toxin injections.

01:51 So now let's return to our case.

01:53 We have a 48-year-old woman presenting with sudden onset pain that mimics cardiac angina.

01:59 And her difficulty with swallowing both solids and liquids indicates an underlying motility disorder.

02:06 So all of these things combines should prompt you to think about diffuse esophageal spasm.

02:11 And the best test to diagnose it is with esophageal manometry.

02:16 You might have thought about a barium swallow study but this may be falsely normal if an episode is not occurring at the time of the test.