Snap Shot A 72-year-old woman is brought to the emergency room complaining of chest pain and difficulty swallowing. Barium swallow is shown. It is determine via manometry that there is 180mmHg of pressure created by the esophagus during peristalsis. Introduction Benign, non-progressive motility disorder of the esophagus, also known as hyperperistalsis Very strong perstalitic waves that can produce pressure up to or exceeding 180mmHg Epidemiology can occur in any age group, but most commonly in 60-70 years of age Associated with obesity, GERD, and metabolic syndrome Presentation Symptoms symptoms may occur with or without food ingestion and include spontaneous chest pain that radiates to back, ears, and neck difficulty swallowing Physical exam usually no obvious signs on physical exam Evaluation Upper GI/esophageal contrast study may show corkscrew esophagus Manometry increased esophageal pressures (>180mmHg) Endoscopy to rule out secondary obstructions Differential Angina, psychoneurosis, achalasia, diffuse esophageal spasm, carcinoma/malignancy Treatment Medical management symptom control reflux meds for GERD nitrates to relieve spasms/chest pain Ca-channel blockers to relax the LES reduce visceral sensitivity trazadone botulinum toxin injections lifestyle changes weight loss dieting Surgical intervention Heller myotomy indicated only for the most severe and recurrent cases relaxes the LES and myenteric plexus Prognosis and Complications Prognosis very good to excellent, given the non-progressive nature of the disease may require aggressive symptom management for best outcomes Prevention none Complications usually chronic and intermittent