What Is an Esophageal Spasm?

An esophageal spasm is the sudden, abnormal squeezing of the food pipe (esophagus). That’s the tube that carries food from your mouth to your stomach.

Causes

Doctors aren't 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.

Symptoms of Esophageal Spasms

The main ones 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)
  • Heartburn

Very hot foods or liquids may trigger spasms or make them worse. Use of certain medications, like narcotic pain relievers (opiates), may cause spasms in some people.

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.

Your doctor also will check for signs of gastroesophageal reflux disease (GERD), which can cause heartburn and make it hard to swallow. You can have both GERD and esophageal spasms.

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 him 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.

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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 him about this condition. Esophageal spasms that come and go sometimes take years to diagnose.

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.

Some reports suggest peppermint oil or lozenges may be helpful for some people with esophagus spasms. Peppermint is a natural smooth muscle relaxant. But there aren’t many long-term studies of peppermint oil in people with this condition.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on April 29, 2019

Sources

SOURCES:

Current Opinion in Gastroenterology: “Distal esophageal spasm.”

Merck Manual Professional Version: “Symptomatic Diffuse Esophageal Spasm.”

Keck School of Medicine of USC: “Diseases and Disorders: Esophageal Motility Disorders.”

Gastroenterology Clinics of North America: “Esophageal Spasm: Demographic, Clinical, Radiographic, and Manometric Features in 108 Patients.”

Cedars-Sinai: “Diffuse Esophageal Spasm.”

Gastroenterology and Hepatology. “Diffuse Esophageal Spasm in the Era of High-Resolution Manometry.”

Mayo Clinic: “Esophageal Spasms.”

UpToDate.com: "Major Diagnosis of Esophageal Hyperperistalsis." 

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