Diffuse esophageal spasm (DES), redefined as distal esophageal spasmDistal esophageal spasm (DES) in the Chicago Classification v4.0, is a rare esophageal motility disorder characterized by premature contractions in the distal esophagus without impaired esophagogastric junction relaxation. Patients typically present with intermittent dysphagia and non-cardiac chest painNon-cardiac chest pain (NCCP), symptoms often difficult to distinguish from angina. Although the etiology remains unclear, dysfunction of nitric oxide–mediated inhibitory pathways have been suggested. High-resolution manometry is central to diagnosis, requiring at least 20% premature contractions with normal integrated relaxation pressure. Imaging may reveal a “corkscrew” esophagus, while endoscopy often yields nonspecific findings. DES must be differentiated from achalasia type III, esophagogastric junction outflow obstruction, and secondary motility disorders. No established treatment exists; management begins with reassurance and proton pump inhibitors, followed by smooth muscle relaxants (nitrates, calcium channel blockersCalcium channel blockers), phosphodiesterase inhibitors, or antidepressants. Endoscopic and surgical options, including balloon dilation, botulinum toxin injection, and peroral endoscopic myotomy (POEM)Peroral endoscopic myotomy (POEM), are considered in refractory cases. DES may progress to achalasia, suggesting a disease spectrum. Advances in manometric criteria and minimally invasive endoscopic therapy are improving diagnostic accuracy and therapeutic outcomes, but further studies are required to clarify long-term prognosis and optimize treatment strategies.