Esophageal Spasms

Esophageal Spasms

WHAT ARE ESOPHAGEAL SPASMS?

When the muscular tube that connects your mouth to your stomach (the esophagus) tightens or contracts abnormally, it is known as spasm. Esophageal spasms are not very common.

There are two types of esophageal spasms:

• Diffuse esophageal spasms – These spasms occur only occasionally. It can be very painful, and it may cause food or liquids to come back up.
• Nutcracker esophagus, also known as jackhammer esophagus – Although these contractions are painfully strong, it is less likely that food or liquids will come back up.  

The board-certified gastrointestinal specialists at Loma Linda University Health provide advanced care for the most complex conditions, including esophageal spasms. We treat more people with esophageal conditions than any center in the region.

WHAT ARE THE SYMPTOMS OF ESOPHAGEAL SPASMS?

One sign that you may be experiencing an esophageal spasm is It may feel like food is stuck in your throat. Other symptoms include:

• A feeling of heartburn or a squeezing type of chest pain
• Chest pain that may spread to the neck, arm or back
• If you try to swallow food or liquid during a spasm, it may come back up within seconds

Symptoms can be constant or come and go.

WHAT CAUSES ESOPHAGEAL SPASMS?

Although the cause of esophageal spasms isn’t clear, these spasms may be related to abnormal functioning of the nerves that control the muscles you use to swallow.

Consuming very hot or very cold foods or drinks, or foods that are not chewed enough before swallowing may trigger a spasm.

Sometimes, symptoms that may suggest esophageal spasm are the result of another condition such as gastroesophageal reflux disease (GERD) or achalasia.

HOW ARE ESOPHAGEAL SPASMS DIAGNOSED?

Diagnosing esophageal spasms begins with a patient history. Depending on your symptoms, your doctor may order one or more of the following tests or procedures:

• Endoscopy – A flexible tube is put down your throat so your doctor can see inside the esophagus
• Biopsy – Your doctor may remove a tissue sample (biopsy) during the endoscopy to test and rule out other possible diseases
• X-ray – Pictures of your esophagus are taken after you swallow a contrast liquid
• Esophageal manometry – This is a test to measure contractions in your esophagus when you drink water
• Esophageal pH monitoring – This test will indicate if stomach acid is coming back into your esophagus (acid reflux).

At Loma Linda University Health, we offer the most advanced technologies found only in major metropolitan academic medical centers to diagnose esophageal spasms, as well as all other types of esophageal condition.

HOW ARE ESOPHAGEAL SPASMS TREATED?

Treatment for esophageal spasms will vary depending on the frequency and severity of the spasms. Treatment recommendations may include:

Lifestyle changes and home remedies

These are the first steps in reducing or eliminating occasional esophageal spasms. To help reduce occasional esophageal spasms, try to:

• Avoid triggers – Identify foods and beverages that seem to cause your esophageal spasms and avoid them.
• Adjust food and beverage temperatures – Let very hot or very cold foods and drinks sit long enough to cool a bit before eating or drinking them.
• Control your stress – Esophageal spasms seem to be more common or more severe in people who are feeling stressed. Control stress by getting more sleep, using relaxation techniques and avoiding caffeine.
• Take a peppermint lozenge – Peppermint oil is a smooth-muscle relaxant and might help ease esophageal spasms. Put the lozenge under the tongue.

Medications

A proton pump inhibitor like lansoprazole may be used to treat GERD, or an antidepressant, like trazodone or imipramine (Tofranil®) may help to reduce or eliminate spasms. Antidepressants may also reduce pain in the esophagus. Using certain medications to relax swallowing muscles like Sildenafil (Revatio®, Viagra®), Botox™ injections may help. Diltiazem (Cardizem® CD, Tiazac, and others) are calcium channel blockers that may reduce the severity of esophageal spasms.

Myotomy Surgery

If medication, lifestyle changes and home remedies don’t sufficiently reduce or eliminate esophageal spasms, myotomy surgery may be recommended. In this procedure, the muscle at the lower end of the esophagus is cut to weaken esophageal contractions. Long-term studies of myotomy are not yet available.

Peroral endoscopic myotomy (POEM)

POEM is a minimally-invasive treatment for esophageal spasms. An endoscope is inserted through the mouth and down the throat to make an incision in the inside lining of the esophagus. The surgeon cuts the muscle at the lower end of the esophagus. Like myotomy, POEM is usually considered only if other treatments don't work.

WHAT ARE THE COMPLICATIONS OF ESOPHAGEAL SPASMS?

If your esophageal spasms remain untreated, many people continue experiencing difficulty swallowing, chest pain and heartburn in addition to other symptoms of esophageal spasms.

WHO IS AT RISK FOR ESOPHAGEAL SPASMS?

People between the ages of 60 and 80 are at the highest risk of getting esophageal spasms.

In addition, the risk of developing esophageal spasms seems to increase in people who have high blood pressure, anxiety or depression. Drinking red wine or consuming very hot or very cold foods or drinks also seems to increase the risk of developing esophageal spasms.

Because esophageal spasms seem to be associated with gastroesophageal reflux (GERD) disease, those at risk for GERD may also be at greater risk of developing esophageal spasms.

NEXT STEPS

Be proactive. If you are having difficulty swallowing or experiencing the other symptoms of esophageal spasms, seek medical attention. To request an evaluation at Loma Linda University Health, contact this department or schedule the appointment through MyChart.