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.
How the Esophagus Works
The exact cause of esophageal spasm is not known but is suspected to be a nerve defect.
Sometimes, esophageal spasm does not cause any symptoms.
When it does cause symptoms, 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.
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).
Because the chest pain of esophageal spasm is similar to that of angina (chest pain resulting from poor blood flow to the heart), doctors do tests to rule out angina. Tests may include electrocardiography (ECG), exercise stress testing, or other tests.
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.
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, a trial of botulinum toxin injections into the lower esophageal sphincter may be tried.
Some people have symptoms that are severe and difficult to treat. Sometimes, a surgeon may cut the muscle layer along the full length of the esophagus (myotomy). Alternatively, a gastroenterologist may cut this muscle layer during endoscopy.
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