Diffuse oesophageal spasm

What it is

Diffuse oesophageal spasm is a motility disorder of the oesophagus that produces episodes of chest pain and intermittent dysphagia to both solids and liquids. It presents in late middle age and is associated with degeneration of the nerves in Auerbach's plexus, as achalasia is, and it can rarely evolve to achalasia.

The two accounts of the abnormal contraction differ and are worth holding together: the waves are described as non-effective peristaltic waves of high amplitude in one source, and as contractions of normal amplitude that are uncoordinated, simultaneous or rapidly propagated in another.

How it presents

The main complaint is retrosternal chest pain that mimics angina, of sudden onset and precipitated by drinking cold liquids. Alongside it:

• Intermittent dysphagia for solids and liquids together.
• Odynophagia.
• Heartburn and regurgitation.

It can be secondary to GERD.