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Esophageal Spasm

Topic Overview

What is esophageal spasm?

Normally, contractions of the esophagus (the tube that connects the mouth and the stomach) move food from the mouth to the stomach with a regular, coordinated rhythm.

Esophageal spasm means that contractions of the esophagus are irregular, uncoordinated, and sometimes powerful. 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 the squeezing moves down the esophagus in a coordinated way, but it is very strong. This can be called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain.

Esophageal spasm is not common. Often, symptoms that may suggest esophageal spasm are the result of another condition such as gastroesophageal reflux disease (GERD) or achalasia. Achalasia is a problem with the nervous system in which the muscles of the esophagus and the lower esophageal sphincter (LES) don't work properly. Anxiety or panic attacks can also cause similar symptoms.

What causes esophageal spasm?

The cause of esophageal spasm is unknown. Many doctors believe it results from a disruption of the nerve activity that coordinates the swallowing action of the esophagus. In some people, very hot or very cold foods may trigger an episode.

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 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 esophageal spasm diagnosed?

Your doctor can often find out the cause of esophageal spasm from your medical history by asking you a series of 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 whether you are taking medicines for them.

The diagnosis can be confirmed with tests, including esophagus tests (such as esophageal manometry) or a barium swallow. Esophageal manometry uses a small tube attached to instruments (transducers) that measure pressure. A barium swallow is done using X-rays.

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

How is it 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.

Here are some things to try:

  • Change your eating habits.
    • It's best to eat several small meals instead of two or three large meals.
    • After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
    • Chocolate, mint, and alcohol can make GERD worse. They relax the valve between the esophagus and the stomach.
    • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
  • Do not smoke or use smokeless tobacco.
  • If you have GERD symptoms at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
  • Do not wear tight clothing around your middle.
  • Lose weight if you need to. Losing just 5 to 10 pounds can help.

If lifestyle changes alone aren't enough to help GERD, your doctor may suggest you try medicines that reduce stomach acid. Over-the-counter medicines include:

  • Antacids, such as Maalox, Mylanta, or Tums.
  • Stronger acid reducers, such as famotidine (for example, Pepcid), omeprazole (for example, Prilosec), or ranitidine (for example, Zantac).

Spasms may be treated directly with medicines such as nitrates and calcium channel blockers to relax the muscles of the esophagus. But these medicines don't always work. Your doctor may also recommend certain types of antidepressant medicines. Even though you may not be depressed, these medicines can help with the pain.

Treating anxiety with relaxation and controlled breathing exercises may also help to reduce symptoms.

In rare cases, surgery is used to treat esophageal spasm. The surgeon cuts the muscles along the lower esophagus. This procedure is usually done only in serious cases that do not respond to other therapies.

Other Places To Get Help

Organizations

American College of Gastroenterology
6400 Goldsboro Road
Suite 200
Bethesda, MD 20817
Phone: (301) 263-9000
Web Address: http://patients.gi.org
 

The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.


American Society for Gastrointestinal Endoscopy
1520 Kensington Road
Suite 202
Oak Brook, IL 60523
Phone: 1-866-353-ASGE (1-866-353-2743) toll-free
Phone: (630) 573-0600
Fax: (630) 573-0691
Email: info@asge.org
Web Address: www.asge.org
 

The American Society for Gastrointestinal Endoscopy is a group of doctors who have special training in using endoscopy to look at the digestive tract. On the website you can find a doctor in your area who does these procedures. The website also has patient education videos and patient information about endoscopic procedures.


National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD  20892-3570
Phone: 1-800-891-5389
Fax: (703) 738-4929
TDD: 1-866-569-1162 toll-free
Email: nddic@info.niddk.nih.gov
Web Address: www.digestive.niddk.nih.gov
 

This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.


References

Other Works Consulted

  • Goyal RK, et al. (2009). Esophageal motility disorders section of Oropharyngeal and esophageal motility disorders. In NJ Greenberger et al., eds., Current Diagnosis and Treatment: Gastroenterology, Hepatology, and Endoscopy, pp. 159–171. New York: McGraw-Hill.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Peter J. Kahrilas, MD - Gastroenterology
Last Revised May 22, 2013

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