Differential Diagnosis for Intermittent Tertiary Contractions with Mild Esophageal Dysmotility
- Single Most Likely Diagnosis
- Achalasia: This condition is characterized by the failure of the lower esophageal sphincter to relax, leading to difficulty swallowing, regurgitation, and sometimes chest pain. Intermittent tertiary contractions and mild esophageal dysmotility can be seen in achalasia, especially in its early stages or in less severe forms.
- Other Likely Diagnoses
- Diffuse Esophageal Spasm (DES): DES is a condition where there are uncoordinated muscle contractions of the esophagus, which can lead to chest pain and dysphagia. Tertiary contractions, which are non-peristaltic and can be seen in DES, contribute to the dysmotility.
- Nutcracker Esophagus: This condition involves very powerful esophageal contractions that can cause chest pain and dysphagia. While primarily characterized by strong peristaltic contractions, some patients may exhibit tertiary contractions and mild dysmotility.
- Gastroesophageal Reflux Disease (GERD): GERD can lead to esophageal dysmotility, including tertiary contractions, as a result of chronic inflammation and scarring from acid reflux.
- Do Not Miss Diagnoses
- Esophageal Cancer: Although less common, esophageal cancer can cause dysmotility and tertiary contractions due to the mechanical obstruction and invasion of the esophageal wall. Early diagnosis is crucial for treatment outcomes.
- Scleroderma: This autoimmune disease can lead to fibrosis of the esophageal smooth muscle, resulting in severe dysmotility. While more commonly associated with aperistalsis, scleroderma can present with a range of motility disorders, including tertiary contractions.
- Rare Diagnoses
- Eosinophilic Esophagitis: An inflammatory condition characterized by eosinophilic infiltration of the esophagus, which can lead to dysphagia, food impaction, and esophageal dysmotility, including tertiary contractions.
- Infectious Esophagitis: Certain infections (e.g., candidiasis, herpes simplex virus) can cause esophageal inflammation and dysmotility, though this is less commonly associated with tertiary contractions.
- Chagas Disease: Caused by Trypanosoma cruzi, this disease can lead to destruction of the myenteric plexus of the esophagus, resulting in dysmotility similar to achalasia, including tertiary contractions, though it is rare in non-endemic areas.