Corkscrew esophagus

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]

References

  1. 1 2 3 4 Fonseca, Eduardo Kaiser Ururahy Nunes; Yamauchi, Fernando Ide; Tridente, Cassia Franco; Baroni, Ronaldo Hueb (March 2017). "Corkscrew esophagus". Abdominal Radiology. 42 (3): 985–986. doi:10.1007/s00261-016-0965-7. PMID 27832322.
  2. 1 2 3 Almansa, C.; Heckman, M. G.; DeVault, K. R.; Bouras, E.; Achem, S. R. (April 2012). "Esophageal spasm: demographic, clinical, radiographic, and manometric features in 108 patients". Diseases of the Esophagus. 25 (3): 214–221. doi:10.1111/j.1442-2050.2011.01258.x. PMID 21951821.
  3. 1 2 Schlottmann, Francisco; Patti, Marco G. (30 June 2017). "Primary Esophageal Motility Disorders: Beyond Achalasia". International Journal of Molecular Sciences. 18 (7): 1399. doi:10.3390/ijms18071399. PMC 5535892. PMID 28665309.
  4. ↑ Han, Samuel; Wagh, Mihir S. (30 April 2020). "Corkscrew Esophagus in Achalasia". New England Journal of Medicine. 382 (18): e42. doi:10.1056/NEJMicm1911516. PMID 32348647.
  5. ↑ Sachdeva, Sanjeev; Reddy, Ravi Teja; Chittem, Rahul; Vaithiyam, Venkatesh (4 December 2024). "Corkscrew esophagus due to type-3 achalasia: A rare combination". Indian Journal of Gastroenterology. doi:10.1007/s12664-024-01716-w. PMID 39630366.
  6. ↑ Weissman, J. L. (1993). "Corkscrew esophagus". American Journal of Otolaryngology. 14 (1): 53–54. doi:10.1016/0196-0709(93)90011-U. PMID 8434722.
  7. ↑ Matsuura, Hiroki (February 2018). "Diffuse Esophageal Spasm: Corkscrew Esophagus". The American Journal of Medicine. 131 (2): e45. doi:10.1016/j.amjmed.2017.08.041. PMID 28943381.
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