Esophageal spasms

Esophageal spasms are an uncoordinated series of muscle contractions that prevent food from traveling properly from your esophagus to your stomach. These spasms can be very painful. Chest pain is a common symptom of esophageal spasm.

Treatment of esophageal spasms in the short term may involve using medications to quickly relax the esophageal muscles. Long-term treatment may involve managing any contributing health condition, taking additional medications and altering your eating habits. In some people, esophageal spasms can lead to chronic swallowing problems and pain.

Esophageal spasms affect the smooth (involuntary) muscles in the walls of your lower esophagus. These spasms may occur in two forms:

  • Diffuse spasms. These simultaneous or irregular contractions of esophageal muscles slow down the progress of food toward your stomach.
  • Nutcracker esophagus. Food may progress to your stomach normally, but the contractions of your esophageal muscles are painfully strong. People with this type of esophageal spasm don’t experience difficulty swallowing as often as people with diffuse spasms do.

For both forms of esophageal spasms, periods of contractions often occur intermittently.

Signs and symptoms of esophageal spasms include:

  • Pain in your chest, often intense, which you might mistake for heart pain (angina)
  • Difficulty swallowing (dysphagia)
  • The feeling that an object is stuck in your throat (globus)
  • Bringing food back up (regurgitation)
  • Heartburn, a burning sensation that may radiate from your upper abdomen to your neck, sometimes leaving a sour taste in your mouth

Esophageal spasms can be difficult to diagnose because of their similarity to other disorders, such as gastroesophageal reflux disease (GERD), a condition in which stomach acid or bile flows back (refluxes) into your esophagus, irritating its lining.

esophagus
Your esophagus is a long tube-like structure that connects your throat to your stomach. A healthy esophagus moves food into your stomach through a series of coordinated muscular contractions, called peristalsis. Esophageal spasms disrupt this process.

The exact cause of esophageal spasms is unknown. Some possibilities include:

  • * Extremely hot or extremely cold foods, although how these foods may trigger the spasms is unclear
  • * Gastroesophageal disease (GERD) or heartburn, conditions affecting the esophagus and which may trigger spasms

Esophageal spasms are more common in women, and the incidence increases with age. If you have gastroesophageal reflux disease, you may be more prone to esophageal spasms. Your doctor may test you for reflux or try a medication targeted at acid reflux.

Diagnosis

  • Barium swallow (esophagram). This is the best imaging study to help diagnose esophageal spasms and a common test for people who have difficulty swallowing. A barium swallow uses a series of X-rays to examine your esophagus. During the test, you’ll drink a thick liquid (barium) that temporarily coats the lining of your esophagus so that the lining shows up clearly on X-ray images. You may also be asked to swallow a barium pill to see if it gets hung up in the esophagus.After the test, you can eat normally and resume your daily activities, although you’ll need to drink extra water to help flush the barium from your system and prevent constipation.
  • Esophageal motility (manometry) test. In this test, your doctor inserts a thin tube through your nose or mouth into your esophagus to measure the effectiveness of your esophageal muscles in the swallowing process.
  • Esophageal computerized tomography (CT) scan. CT scans use an X-ray-generating device that rotates around your body and a powerful computer to create cross-sectional images, like slices, of the inside of your body. This test may show abnormal thickening of your esophageal muscles, a possible indicator of esophageal spasms. This test is usually done to rule out other causes of your symptoms.
  • Esophagogastroduodenoscopy (EGD). In this test, you’re sedated and an endoscope is passed through your mouth and down your throat to look directly at your esophagus. This test is useful for finding any blockages in your esophagus that may cause pain or difficulty swallowing, and it may also show irritation of your esophagus from acid reflux.

Treatment for esophageal spasms may include:

  • Managing any underlying conditions. Conditions such as heartburn or GERD may trigger spasms, and treating these conditions may lessen the likelihood of esophageal spasm symptoms. Treating any underlying psychological disorders, such as anxiety or depression, also may help relieve esophageal spasms.
  • Behavior modification. Your doctor or a dietitian may suggest avoiding very hot or very cold foods. Avoiding large meals and eating slowly also may be advised.
  • Medications. Smooth muscle relaxants, such as calcium channel blockers or nitrates, can reduce the severity of contractions. Your doctor may also prescribe tricyclic antidepressants, such as trazodone and imipramine (Tofranil), to reduce pain. When solely treating esophageal spasms, these medications are given in lower doses than those needed to treat depression. Injection of botulinum toxin into the esophagus has also shown some benefit, but doctors approach this treatment with caution, and only after other treatments have failed. Newer treatments, such as peppermint oil and sildenafil (Viagra), have shown promise in small studies.
  • Surgery. In rare cases, surgery may be an option to make esophageal contractions weaker (myotomy) or to remove your esophagus entirely (esophagectomy).

Your diet may have a dramatic effect on reducing esophageal spasms. Pay attention to which foods seem to cause the spasms.

Avoiding hot, cold or spicy foods, large meals, or foods with a high acid content (such as fruit juice, chocolate and tomatoes) may decrease the occurrence of spasms.