Diffuse esophageal spasm: transforming into achalasia.

Of 130 patients diagnosed to have esophageal motility disorders, transformation of diffuse esophageal spasm (DES) into achalasia was identified in one patient. The clinical syndmme of DES was first described by Hamilton Osgood in 1889. It is characterizedby symptoms of substernal chest pain and dysphagia, tertiary contractions on barium swallow and a manometric pattern of frequent simultaneous contractions, interspersed with normal peristalsis. It accounts for 4-15% of the esophageal motility disorders identified in patients with non-cardiac chest pain. Various lower esophageal sphincter (LES) abnormalities i.e., incomplete sphincter relaxation, hypertensive LES have been reported to coexist with diffuse esophageal spasm. This suggests that some of these disorders may represent a dynamic spectmm of esophageal dysmotility rarely, transforming one into the other condition. This report describes one case transforming from DES to achalasia.