Snap Shot A 47-year-old man presents to the emergency room saying that he is having a heart attack. He reports that the pain started after he ate some of his favorite soup. It is noted that he also had some difficulty swallowing when the symptoms began. Introduction Strong, non-peristaltic contractions of the esophageal body Often precipitated by by ingestion of hot and cold liquids Patients have normal sphincter function Associated with GERD Presentation Symptoms symptoms may occur following ingestion of cold liquids and include difficulty swallowing painful swallowing sudden onset chest pain not related to exertion spontaneous and radiated to back, ears, and neck Physical exam symptomatic relief with nitroglycerin Evaluation Upper GI/esophageal contrast study shows "corkscrew esophagus" Manometry may show high-amplitude, simultaneous contractions (non-peristaltic) Endoscopy - normal EKG - normal Stress test - normal Differential Angina, psychoneurosis, nutcracker esophagus, GERD Treatment Medical management symptomatic relief antacids for GERD nitrates for chest pain/spasms calcium channel blockers Surgical intervention long esophagomyotomy indicated for severe, incapacitating symptoms Prognosis and Complications Prognosis long-term outcomes range widely can be intermittent or chronic Prevention no preventive measures are available at this time Complications condition may not respond to treatment