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Esophageal Spasm

(Spastic Pseudodiverticulosis; Rosary Bead or Corkscrew Esophagus; Symptomatic Diffuse Esophageal Spasm)

By Michael C. DiMarino, MD, Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University

Esophageal spasm is a disorder of the propulsive movements (peristalsis) of the esophagus.

In this disorder, the normal propulsive contractions that move food through the esophagus are replaced periodically by nonpropulsive contractions or excessive muscular contractions (hyperdynamia) or the pressure of the lower esophageal sphincter is increased. In 30% of people with this disorder, the lower esophageal sphincter opens and closes abnormally. The exact cause is not known but is suspected to be a nerve defect.


Muscle spasms throughout the esophagus typically are felt as chest pain under the breastbone coinciding with difficulty swallowing (dysphagia—see Difficulty Swallowing) liquids (especially those that are very hot or cold) and solids. Pain also occurs at night and may be severe enough to awaken a person. Esophageal spasm also may cause severe pain without swallowing difficulty. This pain, often described as a squeezing pain under the breastbone, may accompany exercise or exertion, making it difficult for a doctor to distinguish it from angina (chest pain stemming from heart disease). Over many years, this disorder may evolve into achalasia (see Achalasia), a disorder in which the rhythmic contractions of the esophagus are greatly decreased. Some people have symptoms that combine those of achalasia and esophageal spasm. One such combination of symptoms has been called vigorous achalasia. It features both food retention in the esophagus, which can lead to inhaling small amounts of food into the lungs (aspiration), as well as severe chest pain caused by esophageal spasm.


X-rays taken while the person swallows a barium drink (a barium swallow—see X-Ray Studies) may show that liquid barium does not move normally down the esophagus and that contractions of the esophageal wall are uncoordinated and do not propel the barium. Pressure measurements by manometry (a test in which a tube placed in the esophagus measures the pressure of contractions—see Manometry) provide the most sensitive and detailed analysis of the spasms.


Esophageal spasm is often difficult to treat. Calcium channel blockers such as nifedipine may relieve the symptoms by relaxing the muscles of the esophagus. Sometimes, injecting botulinum toxin into the lower esophageal sphincter is helpful. Other drugs such as nitroglycerin, long-acting nitrates, and drugs with anticholinergic effects (such as dicyclomine) are less successful. Sometimes people need strong pain relievers (analgesics). Some people have symptoms that are very difficult to treat. For these people, the esophagus may be dilated by inflating a balloon inside it or by inserting progressively larger blunt-tipped instruments (bougies). Rarely, a surgeon may cut the muscle layer along the full length of the esophagus (surgical myotomy).

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