When repetitive nonpropulsive contractions are observed in more than 30% of swallows in patients with chest pain or dysphagia, a fluoroscopic diagnosis of diffuse esophageal spasm (DES) is often made. Nevertheless, a diagnostic dilemma occurs in patients with radiographic findings of DES who present with chest pain. Because identical motor abnormalities may be observed in asymptomatic, aging individuals, it is difficult to be certain that the patient's chest pain is actually caused by these motor abnormalities. Thus, chest pain should not be attributed to DES until coronary artery disease or other causes of chest pain have been excluded by appropriate investigations.

Some patients with DES may have abnormal lower esophageal sphincter function with high resting pressures and impaired relaxation of the sphincter in response to swallowing. The latter phenomenon may result in beak-like narrowing of the distal esophagus associated with numerous nonpropulsive contractions (Film .2). It therefore has been postulated that DES and achalasia represent opposite ends of a continuous spectrum of esophageal motor disorders.