Corkscrew esophagus
Radiographic sign of esophageal dysmotility
From Wikipedia, the free encyclopedia
Corkscrew esophagus is a radiographic sign seen on a barium swallow in which the esophagus takes on a twisted, helical outline resembling a corkscrew. It is produced by strong, uncoordinated, non-peristaltic contractions of the esophageal wall that compartmentalize the barium column and give the lumen a curled or beaded shape.[1] When the contractions create a row of bead-like outpouchings, the same appearance is often called rosary bead esophagus.[1] The sign is classically linked to distal esophageal spasm, historically termed diffuse esophageal spasm, but it is not specific to any single condition.[1][2]
Causes
The corkscrew pattern reflects abnormal esophageal motility rather than a fixed structural lesion. Distal esophageal spasm is the disorder most often cited, and in the Chicago Classification this diagnosis is defined by premature contractions, measured as a distal latency under 4.5 seconds, in at least 20% of swallows together with normal relaxation of the lower esophageal sphincter.[3] A similar radiographic appearance has been reported in achalasia, including the spastic (type III) subtype, and in hypercontractile (jackhammer) esophagus.[4][5] Gastroesophageal reflux disease and achalasia are usually considered in the differential when the finding is seen.[6]
Diagnosis
On barium fluoroscopy the esophageal body loses its normal smooth peristaltic stripping and instead shows multiple simultaneous indentations that twist the lumen into a helix.[1] Upper endoscopy may show concentric or circular folds in the distal esophagus that mirror the fluoroscopic picture.[7] The sign is neither sensitive nor specific. In a cohort of 108 patients with distal esophageal spasm at a single centre, most abnormal esophagograms showed only nonspecific changes, and the classic corkscrew appearance was present in just three patients.[2] For this reason high-resolution manometry, not radiography, is used to establish the underlying motility diagnosis.[2][3]
