Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry

Core Tip

Core tip: Distal esophageal spasm (DES) is an esophageal motor disorder that is diagnosed using high-resolution manometry and is classified as a major motility disorder in the Chicago classification of esophageal motility disorder. While the criteria for diagnosis have been revised overtime to achieve a homogenous clinical entity, presentation of DES continues to be heterogenous. This has led to the usage of multiple pharmacological treatment options such as nitrates, phosphodiesterase inhibitors, calcium channel blockers, and tricyclic antidepressants, often resulting in poor symptom management. DES pathophysiology falls within the spectrum of spastic motility disorders, and it may represent a stage in the process of evolution to achalasia, more likely type 3. Patients who have continued symptoms despite medical management might benefit from endoscopic procedures such as botulinum injection and peroral endoscopic myotomy.