Biofeedback and self-regulation in the treatment of diffuse esophageal spasm: a single-case study.

Diffuse esophageal spasm is an uncommon esophageal motor disorder characterized clinically by chest pain and difficulty swallowing. A case is described in which failure of conventional medical treatment in the face of continued weight loss led to consideration for surgery. The need for surgery was obviated by the successful application of relaxation training, which resulted in a significant reduction in painful esophageal spasms, weight gain, and an improvement in psychological state; there was, however, no change in the underlying esophageal motor disorder. The use of a second coping strategy--double swallowing--had an additional beneficial effect, and clinical improvements were maintained and increased at 6-month follow-up. The rationale and the effects of this method at the physiological level are described. It is suggested that double swallowing is a promising new approach to helping patients cope with disordered esophageal motility and that its more general applicability warrants further study.