Esophageal spasm is an uncoordinated contraction of the muscles of the esophagus. The esophagus is the muscular tube that carries food from the mouth to the stomach.
Normally, the esophagus muscles contract and relax in order, from top to bottom. This moves the food from the mouth to the stomach. In esophageal spasm, all the muscles contract in an uncoordinated pattern. This causes pain and fails to move the food along. As a result, the person may have trouble swallowing. Sometimes the condition is triggered by eating hot or cold foods.
Symptoms of esophageal spasm may include: chest painburning or pain with swallowingdifficulty swallowingpalpitations (an abnormal sensation of the beating of the heart)
Women are more likely than men to have esophageal spasm. The cause of the spasms is not known, though gastroesophageal reflux (GERD) is felt to increase the likelihood. Someone who gets spasm after eating hot or cold food may have a hypersensitive esophagus.
If a person's esophageal spasm is triggered by hot or cold foods, he or she should avoid them. If the person has GERD, the provider will treat it with medication.
Esophageal spasm can be diagnosed by a test called manometry. In this test, which takes about 60 minutes, a special tube is inserted down the esophagus. The tube measures the muscle activity of the esophagus.
Abnormal contractions mixed with normal movement suppports the diagnosis. A person with a hypersensitive esophagus may be diagnosed by inflating a long balloon in the person's esophagus. If this causes the same symptoms, preventive methods may work.
Esophageal spasm does not usually lead to more serious problems. The pain, however, can be disabling. Sometimes a person is afraid to eat and becomes malnourished or loses weight.
Esophageal spasm is not contagious and poses no risk to others.
Treatment for esophageal spasm may include: dilation, a procedure in which instruments of increasing size are inserted through the esophagus. However, this usually only provides temporary relief.nitrate medications, such as nitroglycerin. These medications are the same as those used for chest pain caused by heart problems.calcium channel blockers, including nifedipine (i.d., TAdalat, Procardia) and verapamil (i.e., Calan, Covera, Ioptin, Verelan)
An individual with a hypersensitive esophagus sometimes improves with low doses of medications normally used for depression, such as imipramine (i.e., Tofranil) or trazodone (i.e., Desyrel).
Nitrates can cause headaches and low blood pressure. Calcium channel blockers can cause nausea, constipation, and other side effects. Antidepressants can cause side effects that depend on the medication used.
No treatment for esophageal spasm is effective for everyone. Often several approaches will be tried before one works. In many cases, the symptoms will only partially resolve.
The person's symptoms are usually the best guide to how well the treatment for esophageal spasm works. Any new or worsening symptoms should be reported to the healthcare provider.
Medical Knowledge Self Assessment Program XI, Part C, Book 3, p. 1034
Scientific American Medicine 4(I):1-12
