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.
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.
- Dilation. In this treatment, a device is placed down your esophagus to carefully expand any narrow areas of your esophagus. You may need to have the treatment more than once.
- Surgery. Surgery is sometimes used in people who have a problem that affects the lower esophageal muscle (achalasia).
- Medicines. If you can’t have dilation or surgery, your doctor may suggest medicines, such as botulinum toxin, to relax the muscles in the esophagus.
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.
- Vaezi MF, et al. (2013). ACG clinical guideline: Diagnosis and management of achalasia. American Journal of Gastroenterology. Published online July 23, 2013 (doi: 10.1038/ajg.2013.196).