Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of intermittent, severe retrosternal chest pain and dysphagia to both solids and liquids. Symptoms are episodic, non-cardiac in origin, and characterized by high-amplitude, prolonged esophageal contractions. No evidence of weight loss, odynophagia, or regurgitation of undigested food. Symptoms are exacerbated by stress or rapid ingestion.
Clinical Examination Findings
General physical examination is typically unremarkable. Cardiovascular and pulmonary examinations are within normal limits to rule out non-esophageal etiologies of chest pain. Abdominal examination reveals no tenderness, masses, or organomegaly. Neurological assessment is intact.
Treatment Protocol
Management focuses on symptom relief and reduction of esophageal hypercontractility. Initial therapy includes calcium channel blockers (e.g., diltiazem) or phosphodiesterase-5 inhibitors. Refractory cases may require endoscopic botulinum toxin injection or peroral endoscopic myotomy (POEM). Proton pump inhibitors are indicated if concomitant GERD is present.