Corkscrew esophagus is a rare disorder of esophageal motility. Esophagus is commonly called food pipe. It is a muscular tube that connects the throat with upper end of stomach. Swallowed food and liquid passes through esophagus into the stomach. Corkscrew esophagus is a type of diffuse esophageal spasm (DES). This condition is characterized by uncoordinated spasm of esophagus. It may lead to difficulty in swallowing solid as well as liquid. Sometimes there is regurgitation of food. Patient suffering from corkscrew esophagus complains of severe pain in chest which often appears similar to angina.The exact cause of corkscrew esophagus is not known. Some researchers believe it is a fault in the neuromuscular mechanism that triggers such spasms. Corkscrew esophagus is easily diagnosed with X-ray barium swallow. The peculiar corkscrew appearance concludes the diagnosis. Treatment consists of medications that help to reduce spasm. Dietary changes are also beneficial to reduce the risk of spasm.
Causes of Corkscrew Esophagus:
As mentioned earlier corkscrew esophagus is a rare condition of contraction and dilatation of the esophagus. It is one of the types of diffuse esophageal spasm. The disease usually occurs in people over the age of 50 years.Males are predominantly affected by the disease. In majority of cases the condition is associated with gastroesophageal reflux disease. The exact cause of corkscrew esophagus remains obscure. But researchers believe it occurs due to a fault in the neuromuscular mechanism in the wall of lower part of esophagus. For unknown reason the brain may be releasing uncontrolled signals to the nerve endings that innervate the esophagus, especially the distal end of esophagus. Besides other triggers or risk factors believed to cause abnormal spasms of esophagus are depression and anxiety, drinking too much hot or cold beverage.
Symptoms of Corkscrew Esophagus:
Corkscrew esophagus symptoms develop in elderly individual. People between the ages of 50 to 80 are mostly affected. It is a disease in which there is abnormal spasm of lower end of esophagus. The spasm produced gives an appearance of corkscrew or like winding staircase on radiological examination. Following are classical symptoms of diffuse esophageal spasm;
- Chest pain especially during swallowing of food and liquid. The pain is intense and it often mimics as heart pain (angina).
- Dysphagia or difficulty in swallowing solid and liquid.
- Regurgitation of food and liquid.
- Feeling as if something stuck in the throat.
Diagnosis and Treatment:
Corkscrew esophagus can be easily diagnosed with radiographic investigation. After taking medical history and physical examination, the physician will recommend for X-ray Barium swallow. Radiographic finding shows the shape of esophagus similar to rosary bead or corkscrew. Another test is upper GI tract endoscopy. It reveals the lower part of esophagus as spiraling staircase. Manometry of esophagus is a test that helps in evaluating the contraction and relaxation of muscles of esophagus.
Corkscrew esophagus is often triggered due to stress, depression and anxiety. Hence these conditions must be addressed if they are the triggers. Besides, dietary change is valuable in reducing the episodes of abnormal painful spasms of esophagus. Patient must eat bland diet. This will helps to reduce reflux of acid. For protein requirement patient may include lean proteins such as fish, egg, tofu, yogurt, low fat milk etc. Avoid cheese and smoked meat. Avoid pickles and too much oily food. Bland diet consists of broth which can be eaten safely. Avoid coffee, tea, and cold food. Avoid cold beverages as this may lead to spasm. In the same way avoid too much hot tea and coffee.
In majority of people the disease is treated conservatively. Drugs include niroglycerine, calcium channel blockers, hydralazine etc. In certain patients endoscopic balloon dilatation is beneficial. In rare cases surgery may be required.