The mainstay of treatment for DES is medical therapy with calcium channel blockers, and/or tricyclic antidepressants.

• Patients with are treated with calcium channel blockers if dysphagia is predominant , whereas patients with predominant chest pain are treated with either calcium channel blockers or tricyclic antidepressants.
• Nitrate releasing drugs and local injection of botox toxin are used if above measures fail.
• Proton pump inhibitors are used in secondary DES.

• 1 Primary DES
  • 1.1 Adult
    • Preferred regimen (1): diltiazem 180-240 mg PO q24h for 7-10 days. (Contraindications: Hypersensitivity, AV block (2nd or 3rd degree), hypotension, acute MI)
    • Preferred regimen (2): imipramine 25-50 mg at bedtime for 14-21 days.
    • Alternative regimen (2):Isosorbide 10 mg or sildenafil 50 mg PO as needed.
  • 1.2 Pediatric
    • • Preferred regimen (1): diltiazem 1.5-2mg/kg 50 mg/kg PO in 3-4 divided doses.
      • Preferred regimen (2): imipramine 10-25 mg PO per day at bedtime. (maximum, 50mg/day if 6 years to < 12 years and 75mg/day if = or > 12 years).

• 2 Secondary DES (treatment of GERD)
  • 2.1 Adult
    • Preferred regimen (1): omeprazole 20mg PO q24h for 4 weeks
  • 2.2 Pediatric for =<1 year and >= 16yrs
    • Preferred regimen (1): 5kg to <10 kg; omeprazole 5mg PO q24h for 4 weeks
    • 10kg to ,20 kg; omeprazole 10mg PO q24h for 4 weeks
    • >= 20 kg; omeprazole 20mg PO q24h for 4 weeks.

• Refractory cases
• Cases refractory to above treatment,endoscopic injection of Botulinum toxin 100U is the next medical therapy.