Esophageal Spasm

What is esophageal spasm?

Normally, the esophagus (the tube that connects the mouth and the stomach) contracts to move food and liquids from the mouth to the stomach. It does this in a regular, smooth way.

Esophageal spasm means that contractions of the esophagus are not regular and sometimes strong. This condition may be called diffuse esophageal spasm, or DES. These spasms can prevent food from reaching the stomach. When this happens, the food gets stuck in the esophagus.

Sometimes contractions move down the esophagus in a smooth way, but they are very strong. This may be called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain.

Esophageal spasm is not common. It is often related to other conditions such as gastroesophageal reflux disease (GERD) or achalasia. Achalasia is a rare problem with the nervous system in which the muscles of the esophagus and the lower esophageal sphincter (LES) don't work right. Anxiety or panic attacks can also cause symptoms like this.

What causes it?

The cause of esophageal spasm is unknown. Many doctors believe it is a nerve problem that affects the usual regular, smooth contractions of the esophagus. In some people, very hot or very cold foods may trigger a spasm.

What are the symptoms?

Most people with this condition have chest pain that may spread outward to the arms, back, neck, or jaw. This pain can feel similar to a heart attack. If you have chest pain, you should be evaluated by a doctor as soon as possible to rule out or treat cardiac disease.

Other symptoms of esophageal spasm include difficulty or inability to swallow food or liquid, pain with swallowing, the feeling that food is caught in the center of the chest, and a burning sensation in the chest (heartburn).

How is it diagnosed?

Your doctor can often find out the cause of esophageal spasm from your medical history by asking you questions. These include questions about what foods or liquids trigger symptoms, where it feels like food gets stuck, other symptoms or conditions you may have, and if you are taking medicines for them.

Esophagus tests, such as esophageal manometry or a barium swallow, can help diagnose esophageal spasm. Esophageal manometry uses a small tube attached to instruments (transducers) that measure the contractions in the esophagus after swallowing. A barium swallow is done using a chalky white liquid called barium. After you swallow the barium, it shows up in the esophagus on an X-ray so any problems can be seen.

Other tests may be done to find out whether chest pain may be caused by gastroesophageal reflux disease (GERD). GERD is the abnormal backflow (reflux) of food, stomach acid, and other digestive juices from the stomach into the esophagus.

How is esophageal spasm treated?

Treatment for esophageal spasm includes treating other conditions that may make esophageal spasms worse, such as gastroesophageal reflux disease (GERD). GERD is usually treated with changes to diet and lifestyle and medicines to reduce the amount of acid in the stomach.

Other treatment for esophageal spasm may include:

• Changing the foods you eat. Your doctor may tell you to eat certain foods and liquids to make swallowing easier.
• Medicines. Your doctor may suggest medicines that relax the muscles of the esophagus, such as nitroglycerin or calcium channel blockers. Botulinum toxin medicine may also be used.
• Esophageal dilation. A dilator tool is inserted into the esophagus and expanded to widen any narrow parts of your esophagus.
• Surgery. Surgery (called a myotomy) is sometimes used in people when medicines have not worked and they have a problem that affects the lower esophageal muscle (achalasia).