Distal esophageal spasm

DES is a hyper-motility disorder of the esophagus. The pathophysiology of this poorly understood esophageal disorder is unclear. DES most commonly presents with symptoms of chest pain and dysphagia. High-resolution esophageal manometry is the gold standard for diagnosis. There is no standardized treatment algorithm, but a stepwise approach is recommended. Medical management includes treatment with anti-reflux medications and smooth muscle relaxants like nitrates, phosphodiesterase-5 inhibitors, and calcium channel blockers. Injection with botulinum toxin is another treatment option. If symptoms persist, then more invasive treatments like esophageal dilation and the POEM procedure can be considered. Surgical myotomy is reserved for patients that fail all other treatment modalities.