Diffuse esophageal spasm (DES), also known as nutcracker esophagus, is an abnormality of the neural processes in the esophagus leading to intense contractions (spasms).
Patients present with intermittent chest pain (due to spasm) that is not associated with exertion and bears no relation to food. There is intermittent esophageal dysphagia to both solids and fluids that does not progress.
Barium studies show corkscrew esophagus during the time of an attack. Manometric studies show a pattern of disorganized contractions.
Treatment is with calcium channel blockers or nitrates.