A 45-year-old man reports intermittent dysphagia and crushing chest pain provoked by cold drinks. Barium swallow shows a corkscrew appearance with multiple simultaneous contractions. Which manometric pattern confirms the diagnosis?

• A Absent contractility with no peristalsis and absent LES pressure
• B Hypertensive peristalsis with normal latency and elevated distal contractile integral
• C Elevated integrated relaxation pressure with absent peristalsis
• D Premature, rapidly propagated distal oesophageal contractions with preserved LES relaxation ✓

Explanation

Diffuse (distal) oesophageal spasm gives the corkscrew or rosary-bead oesophagus on barium studies. High-resolution manometry defines it as at least 20% premature contractions, meaning distal latency below 4.5 seconds, with normal median IRP. Absent contractility and raised IRP with aperistalsis define achalasia, while hypertensive peristalsis with normal latency describes hypercontractile (jackhammer) oesophagus, a different entity.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.