<s>[INST] context: • Esophageal contractions are repetitive, simultaneous, and of high amplitude.
• Basic pathology is related to a motor abnormality of the esophageal body that is most notable in the lower two thirds of the esophagus.
• More common in women and is often found in patients with multiple complaints. Clinical Features]
• Clinical presentation: Chest pain and dysphagia (may be related to eating or exertion and may mimic angina)
• Complain of a squeezing pressure in the chest that may radiate to the jaw, arms, and upper back.
• The symptoms are often pronounced during times of heightened emotional stress.
Diagnosis
• Barium swallow:
−− Corkscrew or rosary-bead esophagus, segmental spasm or pseudodiverticulosis appearance
−− Due to presence of tertiary contractions
−− Indicative of advanced disease
• Hypermotility disorder also known as supersqueeze esophagus.
• Esophagus with hypertensive peristalsis or high-amplitude peristaltic contractions.
• Most common and most painful esophageal hypermotility disorder.
• Associated with hypertrophic musculature resulting in high-amplitude contractions of the esophagus
Clinical Features
• Chest pain and dysphagia are typical symptoms.
Diagnosis
• The gold standard of diagnosis is the subjective complaint of chest pain with simultaneous objective evidence of peristaltic esophageal contractions 2 standard deviations above the normalQ values on manometric tracings.
• On manometry, amplitude >180 mmHg and duration of contraction >6 seconds
Treatment
• The treatment of nutcracker esophagus is medical (Calcium channel blockers, nitrates, and antispasmodics) 
• The LES pressure is above normal, motility of esophageal body may be hyperperistaltic or normal.
Clinical Features
• Patients with hypertensive LES present with chest pain or dysphagiaQ.
Diagnosis
• Diagnosis is made by manometry.
−− Elevated LES pressure (>26 mm Hg) and normal relaxation of the LES.
−− Esophageal body may be hyperperistaltic or normal.
Treatment
• Botox injections alleviate symptoms temporarily, and hydrostatic balloon dilation may provide long-term symptomatic relief.
• Surgery in patients who fail interventional treatments and those with significant symptoms.
• A laparoscopic modified Heller esophagomyotomy is the operation of choice. [/INST] question: Corkscrew esophagus is seen in which of the following conditions ? | options: A: Carcinoma esophagus B: Scleroderma C: Achalasia cardia D: Diffuse esophagus spasm | answer: D </s>