Motility disorders: The Daily PANCE Blueprint
A 32-year-old male presents to the clinic complaining of trouble swallowing liquids over the past year. He also has had worsening episodes of postprandial chest pain and more upper respiratory infections. A barium esophagram was performed, which showed that the esophagus had an abnormal spiral appearance of peristalsis. Which of the following is the most likely diagnosis?
A. Barrett’s esophagus
B. Laryngopharyngeal reflux
C. Esophageal stricture
D. Autoimmune esophagitis
E. Distal esophageal spasm
Answer and topic summary
The answer is E. Distal esophageal spasm
Esophageal motility disorders are a group of conditions that are defined by abnormal contractions of the esophagus. It includes hypercontractile esophagus (jackhammer esophagus), hypertensive peristalsis (nutcracker esophagus), and distal esophageal spasm (aka corkscrew esophagus). Clinical features include intermittent dysphagia to liquid, chest pain, heartburn, globes sensation, upper respiratory symptoms, etc. Work-up includes upper endoscopy, esophageal barium swallow, and manometry. Treatment for acute episodes includes smooth muscle relaxants (like nifedipine or sildenafil), peppermint oil, and tricyclic antidepressants. Endoscopic botox injections or surgery can be done for refractory cases.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
