A 60-year-old man comes to the clinic for evaluation of difficulty swallowing accompanied by chest pain. The patient had a few of these episodes in the past but did not seek treatment. The episodes occur while he is having a meal, but only occasionally. He describes difficulty in swallowing both liquids and solids. He has not noticed any pain during exertion. Medical history is noncontributory. The patient does not smoke or use illicit drugs, and he drinks alcohol socially. Temperature is 37.0°C (98.6°F), pulse is 75/min, and blood pressure is 125/85 mmHg. ECG shows no abnormalities or ischemic changes. Two subsequent troponin measurements are within normal limits. Which of the following is most likely seen in this patient on further evaluation?

Simultaneous contractions of the lower esophagus on manometry

Contrast-filled pouch in the esophagus on barium swallow

Distal esophageal stenosis on barium swallow test

ST-segment depression on cardiac stress test

Diffuse esophageal spasm

Foundational SciencesPathologyGastrointestinal systemDisorders of the oral cavity, salivary glands, and esophagusEsophagus

Organ SystemsGastrointestinal systemPathologyDisorders of the oral cavity, salivary glands, and esophagusEsophagus

Definitions & Key takeaways

Diffuse esophageal spasm (DES) is a condition characterized by uncoordinated and erratic contractions of the muscles in the wall of the esophagus. These contractions prevent food and liquids from passing through the stomach and can cause chest pain, dysphagia (difficulty swallowing), and regurgitation. DES can mimic myocardial ischemia in that both cause retrosternal intense chest pain, and both are relieved with the administration of nitrates.

Diffuse esophageal spasm

Definitions & Key takeaways

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