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An 89-year-old woman was referred for an upper gastrointestinal examination because of dysphagia, epigastric pain, and frequent belching. A single-contrast barium examination of the patient's esophagus showed a constricted, twisted lumen (upper arrow). This finding, referred to as a "corkscrew" esophagus, can be seen in diffuse esophageal spasm from abnormal, tertiary contractions. Medical management of diffuse esophageal spasm involves the use of muscle relaxants (e.g., nitrates, calcium-channel blockers, and botulinum toxin) and anxiolytic agents (e.g., trazodone) in conjunction with antireflux therapy. Some patients require surgical myotomy. Incidentally, this patient also had a nonstenotic lower esophageal mucosal ring (lower arrow).
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