Diffuse esophageal spasm is best diagnosed by:

Answer is B (Manometry) Diffuse oesophageal spasm is a type of oesophageal motility disorder. Such Motility disorders are best diagnosed by Manometry studies `Esophageal manometry is the key test for establishing the diagnosis of diffuse esophageal spasm' - CSDT `Esophageal manometry is the only test that distinguishes diffuse esophageal spasm from other primary esophageal motor disorders. Diffuse Esophageal spasm: Diffuse Esophageal spasm is a poorly understood hypermotility disorder of the oesophagus Presentation - Symptoms are aggravated by emotional stress, exeion (or related to eating) Diagnosis Manometry is the key to establish the diagnosis The diagnosis is usually made by an esophagogram (Barium swallow) and monometric study Esophagogram Manometry (Barium Swallow) * Manometry is the key to establish the diagnosis (CSDT) * Corkscrew esophagus is classical of Diffuse Correlation of subjective complains with evidence of spasm esophageal spasm (seen in about 30% of cases) (induced by vagomimetic drug bethenechol) on manometric (Radiological evidence of teiary contractions) studies prvide convincing evidence-Sabiston * Esophageal monometry is the only test that distinguishes diffuse esophageal spasm from other primary esophageal motor disorders - CSDT * An ambulatory motility record (ambulatory manometry) is preferred over standard manometry as contractions are intermittent and normal peristalsis is seen in between. Ambulatory manometry is the single best investigation with a sensitivity of 90% and specificity of 100%