Clinical symptoms may include recurrent chest pain and dysphagia
High-resolution manometry is needed for diagnosis. The condition is defined by one or more multi-peaked contraction(s) with a distal contactile integral (DCI) > 8,000 mm Hg per second per cm. The appearance of multiple contractions on manometry is where it gets its nickname.
Endoscopic ultrasonography (EUS) can help to measure the thickness of the muscularis propria. This may be helpful in identify a patient who may benefit from peroral endoscopic myotomy (see below).
Medical management may include:
(1) proton pump inhibitors to reduce gastric acid reflux
(2) smooth muscle relaxant
(3) calcium channel blocker (nifedipine)
(4) phosphodiesterase-5 inhibitors (sildenafil)
(5) low-dose antidepressants to aid in pain control
Non-medical management may include:
(1) pneumatic dilation
(2) peroral endoscopic myotomy (POEM)
(3) injection of botulinum toxin
