Distal esophageal spasm (DES) is best characterized by which finding?

• A. Non-peristaltic contractions of the esophagus, often causing chest pain and dysphagia
• B. Normal peristalsis with reflux symptoms
• C. LES failure to relax
• D. A focal distal esophageal stricture

Answer: (A)

Distal esophageal spasm is a motility disorder in which the esophageal body contracts in a discoordinated, nonperistaltic fashion, especially in the distal portion. This disrupts the normal sequential wave of contraction, so the bolus is not pushed downward smoothly, leading to chest pain and dysphagia. On testing, such as esophageal manometry, you see premature, high-amplitude, nonperistaltic distal contractions with preserved relaxation of the lower esophageal sphincter. The other scenarios describe different problems: reflux symptoms with normal peristalsis point to acid reflux rather than a motor discoordination; a failure of the LES to relax suggests an obstruction like achalasia; and a focal distal stricture reflects a fixed mechanical narrowing rather than a motility disturbance.