Diffuse esophageal spasms DES

• Facts:
  Usually seen in young females
• History / PE:
  Intermittent episodes of chest pain and dysphagia
  Relieved by nitrates and calcium channel blockers
  Odynophagia for hot and cold food
  
• Diagnosis:
  High amplitude peristaltic contractions (diagnostic)
  Normal relation of LES
  "Corkscrew esophagus" (barium swallow)
• Treatment:
  Antispasmotics
  Supportive
• Differential Diagnosis:
  Achalasia
  Myocardial infarction
  Costochondritis
  Gastroesophageal reflux disease