Ans: C (Diffuse esophageal spasm) Ref: Sc ibis ion Textbook of Surgery, 19th Edition 1028Explanation:Diffuse Esophageal spasmHyper motili ty di sorderRepetitive, simultaneous, and of high amplitude esophageal contractionsMotor abnormality of the esophageal body that is more in the lower two thirds.Muscular hypertrophy and degeneration of the branches of the vagus observed.Clinical featuresChest pain and dysphagiaSqueezing pressure in the chest that may radiate to the jaw, arms, and upper back mimicking anginaSymptoms are more during times of emotional stress.Regurgitation of esophageal contents and saliva common.DiagnosisBy esuphagraphy and manometric studiesBarium swallow - Corkscrew esophagus or pseudodiverticulosis due to the presence of tertiary contractionManometrySimultaneous multipeaked contractions of high amplitude (>120 mm Hg> or long duration (>2.5 seconds)Due to spontaneous contractions and intermittent normal peristalsis, standard manometry mayNot be enough to identify DES.An ambulatory manometry has sensitivity of 90% and a specificity of 100% and is preferred.ManagementPharmacologic or endoscopic treatment preferredAll patients require psychiatric evaluationPharmacotherapyNitrates,Calcium channel blockersAnticholinergicsRelative efficacy of each of the drugs not clearEndoscopic managementBougie dilation of the esophagus up to 50 or 60 Fr provides relief for severe dysphagia and is 70% to 80% effective.Botulinum toxin injections have also been triedSurgeryIndicationsPatients with incapacitating chest pain or dysphagia who have failed medical and endoscopic therapyPresence of a pulsion diverticulum of the thoracic esophagus.ProcedureA long esophagomyotomy is performed through a left thoracotomy or a left video-assisted technique.Dor fundoplication - to prevent healing of the myotomy site and provide reflux protectionNote:Barium Swallow appearance of Carcinoma esophagus - Rat tail appearaneeBarium Swallow appearance of Achalasia - Bird's Beak appearance due to dilated esophagus with a distal narrowingGold standard for diagnosing Achalasia - Esophageal manometry.