Describe diffuse esophageal spasm on manometry.

• A. Absent peristalsis with reduced LES relaxation
• B. Normal peristalsis with normal LES relaxation
• C. Premature, simultaneous, often high-amplitude contractions with normal or elevated LES relaxation
• D. Spastic contractions with elevated LES relaxation

Answer: (C)

Diffuse esophageal spasm presents on manometry as discoordinate esophageal body activity: contractions occur prematurely and run simultaneously across segments rather than propagating in a normal, sequential swallow. These contractions can be of high amplitude, contributing to symptoms like chest pain and dysphagia. Importantly, the lower esophageal sphincter relaxes normally during these swallows, and it may be elevated as part of the spasm. This combination—premature, simultaneous, sometimes high‑amplitude contractions with normal or elevated LES relaxation—distinguishes DES from other motility disorders. Absent peristalsis with reduced LES relaxation points to other conditions (like achalasia), normal peristalsis would not fit DES, and spastic contractions with elevated LES relaxation alone aligns more with other disorders such as jackhammer esophagus where peristalsis is preserved.