What is Corkscrew Esophagus & How is it Treated?|Causes & Symptoms of Corkscrew Esophagus

What is Corkscrew Esophagus?

Motility disorders are a group of conditions related to abnormal movement and function of the esophagus. Corkscrew esophagus is a primary motility disorder in which strong spasms of the esophagus occurs. Corkscrew esophagus is also referred to as jackhammer esophagus, nutcracker esophagus, and hypercontractile esophagus. During swallowing, the esophagus contracts to help the food move into the stomach. In corkscrew esophagus, these contractions become stronger and cause chest pain and painful swallowing. Corkscrew esophagus spasms are closely related to diffuse esophageal spasms. The main difference between the two conditions is that corkscrew esophagus spasms usually do not cause regurgitation of food or liquids, while diffuse esophageal spasm often does.

What is Corkscrew Esophagus?

What are the Symptoms of Corkscrew Esophagus?

The main symptom of corkscrew esophagus is painful swallowing. Other symptoms of corkscrew esophagus include: dry cough, heartburn, difficulty in swallowing, and the feeling that something is stuck in the throat. Sudden and severe chest pain, which can lasts for several minutes, or occur on and off for hours, is another symptom of corkscrew esophagus.

What are the Causes & Risk Factors of Corkscrew Esophagus?

Corkscrew esophagus is a rare condition. The cause of corkscrew esophagus is still not known. However, it is believed that corkscrew esophagus is related to a problem with the muscle function, and thickness of the esophagus. Some people only experience these spasms when they eat hot or cold foods. It is common for people with corkscrew esophagus to also have gastroesophageal reflux disease. Females, individuals aged 50 years or more, and people suffering from heartburn or gastroesophageal reflux disease (GERD), face higher risk of developing corkscrew esophagus.

How is Corkscrew Esophagus Diagnosed?

To diagnose corkscrew esophagus, the doctor generally begins by giving the patient a physical exam to exclude the possibility of any underlying conditions. Then the doctor enquires about the frequency of spasms, and if the spasm has any relation with certain foods. So, it is advisable that the patient maintains a food diary and makes a note of the times when they experienced symptoms of corkscrew esophagus during a week or two before visiting a doctor. Based on the results of the exam, the doctor can ask the patient to undergo a diagnostic test like a barium swallow x-ray, esophageal manometry, endoscopic ultrasound, endoscopy, or esophageal pH monitoring, for confirming the diagnosis.

How is Corkscrew Esophagus Treated?

Most cases of corkscrew esophagus can be treated with a combination of medication and home remedies. Additional treatments for corkscrew esophagus may only be required in rare cases.

Medications to Treat Corkscrew Esophagus: Medications which effectively treat corkscrew esophagus are proton pump inhibitors, calcium channel blockers, anti-cholinergic drugs, hyoscyamine, and nitrates, like sublingual nitro-glycerine.

Diet & Relaxation to Manage Corkscrew Esophagus: By drinking warm water, avoiding foods and drinks which cause the corkscrew esophagus symptoms, and practicing relaxation inducing breathing exercises and behavioural techniques, one can relax their esophagus.

Treatment of Corkscrew Esophagus with Botox & Surgery: If medication and home remedies do not bring any relief, the doctor can suggest additional treatments like a POEM procedure (Peroral Endoscopic Myotomy), a botulinum toxin (Botox) injection, or a surgery to cut one of the muscles in the esophagus for weakening contractions.

Final Take

While corkscrew esophagus can be extremely painful, it can be managed with proper medications and techniques for relaxing the muscles in the esophagus. Sometimes, corkscrew esophagus can be managed by simply avoiding certain foods. The patient should keep a track of any patterns they notice with their symptoms. This can help their doctor determine the most suitable treatment plan for corkscrew esophagus.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 14, 2018

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