What Is Esophageal Spasm?
Esophageal Spasms Symptoms
The main symptoms are difficulty swallowing and chest pain. The spasms can be severe enough to wake you from sleep and may feel like a heart attack. If you have sudden chest pain or other signs of a heart attack, call 911 or go to the nearest hospital emergency room.
Other symptoms of esophageal spasms can include:
- Feeling like something is stuck in your throat
- Backward flowing of food or drink (regurgitation)
Causes of Esophageal Spasms
Doctors are not sure what causes esophageal spasms, but it is known that they are a type of motility disorder. That means there’s a problem with how the muscles in the food pipe squeeze together (contract) to move contents through the rest of the gastrointestinal (GI) system. Nerve signals from the brain tell the muscles in your esophagus to contract when you swallow something. Faulty nerve signaling may play a role in whether or not you develop this condition.
There are two main types of esophagus spasms:
Distal esophageal spasm (DES). These are uncoordinated spasms that often happen along with regurgitation. That means food and liquids come back up after you swallow them.
Nutcracker or jackhammer esophagus. A twisted, or corkscrew-shaped, esophagus is often involved in powerful spasms. Regurgitation is not common with this type.
Esophageal Spasm Risk Factors
Esophageal spasms are rare, but there you’re more likely to get them if you:
Esophageal Spasm Diagnosis
Because spasms cause symptoms similar to a heart attack, your doctor will first run tests to check your heart health. It’s important to rule out angina, a type of chest pain caused by coronary artery disease.
Tests your doctor may order include:
Upper endoscopy. The doctor inserts a flexible scope with a camera on the end into your esophagus. This allows them to see your esophagus and stomach. It can help diagnose or rule out GERD and other GI conditions. Ultrasound performed during an endoscopy may show thickening of the esophagus that can trigger esophageal spasm.
Barium swallow. You drink a thick, chalky liquid (contrast) before having an X-ray of your esophagus. The images show how well the liquid moves from your esophagus to your stomach. This test can help to diagnose nutcracker esophagus.
Manometry. This is the only test that can confirm esophageal spasms. During this procedure, the doctor inserts a thin tube into your esophagus. Sensors on the tube measure pressure in the esophagus and reveal how well the muscles relax when you swallow.
If you have repeated episodes of chest pain but your doctor has ruled out heart problems and GERD, talk to them about this condition. Esophageal spasms that come and go sometimes take years to diagnose.
Esophageal Spasm Treatment
These painful events can happen without warning and are often challenging to treat. Options include:
Medications. The goal of taking medicine is to relax the smooth muscle of the esophagus. One of the first recommendations may be to take peppermint oil or lozenges. Peppermint is a natural smooth muscle relaxant. If this doesn't work, you may be asked to try a calcium channel blocker, often also given for heart issues, or a tricyclic antidepressant.
Botulinum injections into the esophagus. This treatment relaxes the muscles of the esophagus. It’s considered a helpful treatment for people with spasms. But the relief is temporary. You’ll need repeated injections every few months.
Surgery. The only permanent cure for esophageal spasms is a surgical procedure called myotomy. The surgeon cuts the thick muscle in the lower part of the esophagus. This is only recommended in severe cases when medications and injections don’t work.
Esophageal Spasm Home Care
Alongside your treatment, you can also help manage your esophageal spasms at home. You can:
- Know and avoid your triggers. Make a list of the things that cause your spasms, and work to stay away from them.
- Watch food and drink temperature. Give foods that are very hot or very cold a chance to come to a more moderate temperature before you eat or drink them.
- Control your stress. Stress ramps up spasms, so try to keep a check on your stress levels.