During medical school I remember learning about a lot of different conditions that had very strange manifestations,

but that's kind of the cool part about learning clinical medicine.

I remember thinking to myself, am I ever going to see a Waldenstrom's macroglobylenemia?

Will I ever see a rouleau on an actual slide?

Will I see a patient with systemic sclerosis,

or maybe a nutmeg liver from congestive epitopathy.

And then there was one condition that stuck out because it had a rather strange name.

It was a jackhammer esophagus.

It turns out, this past week, I've seen several of of them and you might be thinking maybe it's because you're a gastrantroologist and there's a sampling bias

You're right, but it's not that common and it's also one of the things that gives a lot of

clinicians a lot of difficulty. So this week in the esophagus series

we're going to be talking about basic things that do with esophagial

dismodility like distal esophagial spasm which we used to call diffused asophageal spasm, and hyper-contractile

spasm, or also known as Jackhammer esophagus.

I'm Dr. Nakedzion, your friendly-neabered internist,

gastronterologist, and let's jump into this week's topic, distill esophageal esophagus. Now when it comes to distill esophagial spasm, the first thing we need to discuss is why it happens

and how common it is it. Well, the tough thing here is that with DES, nobody really knows

why. We think that there may be a hypothesis regarding a decrease in

nitric oxide meaning that without enough nitric oxide there's going to be sort of a

hyper spasmotic smooth muscle.

We also know that there may be a role of esophageal acid exposure

and in some patients chronic opiate exposure.

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