What Are the Basics of Esophageal Spasms?

Overview

Esophageal spasms are abnormal contractions of the muscles in the esophagus (food pipe). They can feel like sudden, severe chest pain that lasts from a few minutes to hours. There are two types of esophageal spasms:esophagus anatomy

  • Occasional contractions (diffuse esophageal spasms). It may painful and is often accompanied by regurgitation of food or liquids.
  • Painfully strong contractions (nutcracker or jackhammer esophagus). Although painful, it may not cause regurgitation of food or liquids.

 

Signs and symptoms

  • Squeezing pain in your chest. The pain is often intense, and you might mistake it for heart pain (angina).
  • Difficulty swallowing, sometimes related to swallowing specific substances, such as red wine or extremely hot or cold liquids.
  • A feeling of an object stuck in your throat.
  • The return of food and liquids back up your esophagus (regurgitation).

 

Causes

The cause of esophageal spasms is unknown. However, the nerves that control the muscles when you are swallowing may work abnormally, thus leading to esophageal spasms.

Diagnosis

Your doctor might recommend:

  • Endoscopy.
    The doctor will pass a flexible tube (endoscope) down your throat to see the inside of the esophagus. Then he/she may remove a tissue sample for testing (biopsy).
  • Barium swallow and X-ray.
    The patient need to swallow a solution containing barium and then take the X-ray while barium moves down the esophagus. If a stricture is present, the barium may become stuck or slows down.
  • Esophageal manometry.
    This test measures muscle contractions in your esophagus when you swallow water.
  • Esophageal pH monitoring.
    This test can determine if stomach acid is flowing back into your esophagus (acid reflux).

Treatments

If your spasms are occasinal, your doctor might recommend avoiding trigger foods or situations. If the spasms are frequent and make it difficult to eat or drink, your doctor might recommend:

  • Medications to relax your swallowing muscles, including:
    Sildenafil (Revatio, Viagra),
    onobotulinumtoxin A (Botox) injections or
    calcium channel blockers, such as diltiazem (Cardizem CD, Tiazac, others),
  • Managing underlying conditions.
    Esophageal spasms are sometimes related to heartburn, GERD, anxiety or depression. So, your doctor might recommend a proton pump inhibitor to treat GERD or an antidepressant, such as trazodone or imipramine (Tofranil)
  • Surgery (myotomy).
    If medication doesn’t work, your doctor might recommend a procedure that involves cutting the muscle at the lower end of the esophagus, to weaken esophageal contractions.
  • Peroral endoscopic myotomy (POEM).
    This is a new minimally invasive technique. The doctor will insert an endoscope through your mouth and down your throat. Then, as in myotomy, the surgeon cuts the muscle at the lower end of the esophagus. POEM is also considered only if other treatments don’t work.

Lifestyle and home remedies

If the spasms are not severe, you can change your lifestyle to ease the symptoms:

  • Avoid your food triggers.
  • Find ways to control your stress.
  • Avoid very hot or cold foods and drinks.
  • Place a peppermint lozenge under your tongue.

 

Keywords: esophageal spasms

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.