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Esophageal Spasm

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

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, Perelman School of Medicine at The University of Pennsylvania

Esophageal spasm is a disorder of the rhythmic waves of muscular contractions (peristalsis) of the esophagus.

  • The cause of this disorder is not known.

  • Symptoms include chest pain and difficulty swallowing.

  • The diagnosis is based on the results of barium swallow x-rays and manometry.

  • Treatment includes calcium channel blockers or sometimes injections of botulinum toxin.

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach.

In this disorder, the normal propulsive contractions that move food through the esophagus are replaced periodically by nonpropulsive contractions or excessive muscular contractions (hyperdynamia) that do not move food through the esophagus.

In up to 30% of people with this disorder, the lower esophageal sphincter opens and closes abnormally. The lower esophageal sphincter is the ring of muscle that holds the bottom of the esophagus closed so that food and stomach acid do not flow back up the esophagus. When people swallow, this sphincter normally relaxes to allow food into the stomach.

The exact cause of esophageal spasm 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) 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).

Some people have symptoms that combine those of achalasia (a disorder in which the rhythmic contractions of the esophagus are greatly decreased) and esophageal spasm because, in both disorders, the lower esophageal sphincter does not open properly. 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.


  • Barium swallow x-rays

  • Manometry

Doctors do a barium swallow. In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see. This test may show that the barium does not move normally down the esophagus and that some of the contractions of the esophageal wall are uncoordinated and do not move the barium.

Pressure measurements by manometry (a test in which a tube placed in the esophagus measures the pressure of contractions) provide the most sensitive and detailed analysis of the spasms.


  • Calcium channel blockers

  • Sometimes injections of botulinum toxin

  • Rarely surgery

Esophageal spasm is often difficult to treat. Calcium channel blockers such as nifedipine may relieve the symptoms by relaxing the muscles of the esophagus. Tricyclic antidepressants are also used to relax muscles and may also be given.

Other drugs such as nitroglycerin, long-acting nitrates, and drugs with anticholinergic effects (such as dicyclomine) are less successful.

If drugs do not help, sometimes doctors inject botulinum toxin into the lower esophageal sphincter.

Some people have symptoms that are very difficult to treat. Rarely, a surgeon or gastroenterologist may cut the muscle layer along the full length of the esophagus (myotomy).

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