What is an Esophageal Spasm?
Esophagus is the tube, which connects the stomach to the mouth. Contractions normally occur in the esophagus, which enables the food to move from the mouth to the stomach. These contractions occur in a regular and coordinated rhythm. Esophageal spasm is a condition where the contractions of the esophagus become uncoordinated, irregular and in some cases powerful. Having an esophageal spasm prevents the food from entering the stomach and instead remains stuck in the esophagus. This condition can also be called as diffuse esophageal spasm (DES). Sometimes the spasm travels down the esophagus in a coordinated manner, but is very strong. This condition is called nutcracker esophagus, where the contractions although help move the food through the esophagus, however, cause extreme pain.
Esophageal spasms can be felt like a sudden, severe chest pain lasting for a few minutes to some hours.
Esophageal spasm is not a common condition. Symptoms which may indicate esophageal spasm often occur due to other conditions, such as achalasia or gastroesophageal reflux disease (GERD). Panic attacks or anxiety can also cause symptoms similar to esophageal spasm.
Treatment may not be always needed for esophageal spasms, as they tend to occur occasionally. However, if esophageal spasms have become a frequent occurrence and prevents food and liquids from entering the stomach and is causing disruption in a person's ability to drink or eat then immediate treatment should be sought.
Causes & Risk Factors of Esophageal Spasms
The exact cause of esophageal spasm is not clear. It is thought to be associated with abnormal function of the nerves, which are responsible for controlling the muscles used for swallowing. As mentioned before esophageal spasms do not occur often. Some of the factors which increase the risk of esophageal spasms are:
- Individuals aged between 60 and 80 years have a greater tendency to experience esophageal spasms.
- Esophageal spasms can be associated with GERD/gastroesophageal reflux disease.
- High blood pressure (hypertension) can trigger esophageal spasms.
- Anxiety or depression can also cause esophageal spasms.
- Consuming very hot or very cold drinks/foods increases the risk for having esophageal spasm.
- Drinking red wine increases the risk for experiencing an esophageal spasm.
Types of Esophageal Spasms
- Diffuse Esophageal Spasms (DSE): These are the occasional contractions where the spasm is painful and is commonly accompanied by regurgitation of liquids or food.
- Nutcracker Esophagus: This type comprises of very painful and strong contractions and may not cause regurgitation of liquids or food. This type of esophageal spasm is also known as jackhammer esophagus.
Signs & Symptoms of Esophageal Spasm
- One of the symptom of esophageal spasm is acute squeezing pain is felt in the chest. This pain can also radiate to the back, arms, jaw and neck and can be mistaken for angina.
- Burning sensation (heartburn) can be felt in the chest along with a feeling that food is stuck in the middle of the chest can also be a sign and symptom of esophageal spasm.
- Patient suffering from esophageal spasm also experiences difficulty in swallowing food and liquids. Pain can also be felt with swallowing (dysphagia).
- Difficulty in swallowing can be felt with specific items, such as extremely hot or cold liquids or red wine.
- Sensation of something stuck in the throat is a common symptom of esophageal spasm.
- Regurgitation i.e. the food and drinks getting back up into the esophagus.
- Immediate medical attention should be sought if the patient is having squeezing chest pain radiating to shoulders, back and jaw region, as this could also occur due to heart attack.
Diagnosis of Esophageal Spasm
- Barium swallow is done using x-rays of the esophagus after the patient has swallowed a contrast liquid.
- Endoscopy is a test where the endoscope, which is a flexible tube, is passed down the throat so that the inside of the esophagus can be viewed.
- Biopsy, where a tissue sample is taken, can be done during endoscopy for ruling out other diseases of the esophagus.
- Esophageal manometry is a test which measures contractions of the esophageal muscles upon swallowing water.
- Esophageal pH monitoring is a test which determines if the stomach acid is regurgitating into the esophagus (acid reflux).
Treatment for Esophageal Spasm
Treatment of esophageal spasms depends on the severity and frequency of the spasms. If the esophageal spasms are not frequent and happen only occasionally, then just avoiding foods and situations which trigger this condition suffices. If the esophageal spasm is making it difficult to consume any solids or liquids and is interfering with the patient's life, then the following is recommended:
- Esophageal spasms occurring due to any underlying medical conditions, such as GERD, heartburn, anxiety or depression needs treatment of these conditions. For treating GERD, the doctor may prescribe a proton pump inhibitor (lansoprazole). In case of anxiety and depression, the doctor can prescribe an antidepressant. Antidepressants also help in reducing the pain sensation in the esophagus.
- Medications which help in relaxing the muscles used in swallowing can be prescribed to treat esophageal spasm. Medications, such as sildenafil, Botox injections and calcium channel blockers can help in reducing the severity of the esophageal spasms.
- Surgery to treat esophageal spasm, such as myotomy, can be done if the medications do not provide relief. Myotomy is a surgical procedure where the muscle at the lower end of the esophagus is cut so that the esophageal contractions are weakened. Research is still going on for this procedure and myotomy usually is not recommended for treating esophageal spasms, but can be considered if other treatment modalities fail.
- Peroral endoscopic myotomy (POEM) is a new minimally invasive procedure, where an endoscope is passed through the mouth and down the throat to make an incision in the internal lining of the esophagus. The surgeon then cuts the muscle present in the lower end of the esophagus. POEM is also considered only when other treatments fail to provide relief.
Home Remedies & Prevention of Esophageal Spasm
- Foods and beverages which trigger the esophageal spasms should be avoided.
- Try to control your stress as much as possible by exercising daily and meditating, as stress also triggers esophageal spasms or worsens them.
- Avoid drinking or consuming foods and drinks which are very cold or very hot and let them sit a while before drinking or eating them.
- Sucking a peppermint lozenge by placing it under the tongue helps in relieving the esophageal spasm, as the peppermint oil acts as relaxant for smooth muscles and helps in alleviating the esophageal spasms.