A 60-year-old woman presents with episodic chest pain and dysphagia occurring with both solids and liquids, unrelated to posture. Barium swallow shows simultaneous non-peristaltic contractions of the oesophagus producing multiple indentations resembling a corkscrew, with normal relaxation at the gastro-oesophageal junction. Which is the most likely diagnosis?

• A Achalasia cardia
• B Oesophageal candidiasis
• C Diffuse oesophageal spasm ✓
• D Hypertensive lower oesophageal sphincter

Explanation

Diffuse oesophageal spasm produces the classic corkscrew or rosary bead appearance on barium swallow, caused by simultaneous, repetitive, non-propulsive tertiary contractions involving a long segment of the oesophageal body. The lower oesophageal sphincter relaxes normally, which distinguishes it from achalasia, where there is a bird-beak narrowing with failed LES relaxation and absent primary peristalsis. Manometrically, the hallmark is repetitive simultaneous contractions interspersed with some normal peristalsis.

Reference: Gore and Levine Textbook of Gastrointestinal Radiology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.