If you are experiencing a medical emergency please dial 911 immediately
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.
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.
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).
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.
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.
Here are some things to try:
If lifestyle changes alone aren't enough to help GERD, your doctor may suggest you try medicines that reduce stomach acid. Over-the-counter medicines include:
Spasms may be treated directly with medicines such as nitrates and calcium channel blockers to relax the muscles of the esophagus. But these medicines don't always work. Your doctor may also recommend certain types of antidepressant medicines. Even though you may not be depressed, these medicines can help with the pain.
Treating anxiety with relaxation and controlled breathing exercises may also help to reduce symptoms.
In rare cases, surgery is used to treat esophageal spasm. The surgeon cuts the muscles along the lower esophagus. This procedure is usually done only in serious cases that do not respond to other therapies.
|American College of Gastroenterology|
|6400 Goldsboro Road|
|Bethesda, MD 20817|
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
|American Society for Gastrointestinal Endoscopy|
|1520 Kensington Road|
|Oak Brook, IL 60523|
|Phone:||1-866-353-ASGE (1-866-353-2743) toll-free|
The American Society for Gastrointestinal Endoscopy is a group of doctors who have special training in using endoscopy to look at the digestive tract. On the website you can find a doctor in your area who does these procedures. The website also has patient education videos and patient information about endoscopic procedures.
|National Digestive Diseases Information Clearinghouse|
|2 Information Way|
|Bethesda, MD 20892-3570|
This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.
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.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Peter J. Kahrilas, MD - Gastroenterology|
|Last Revised||May 22, 2013|
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