Merck Manual

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Esophageal Spasm

(Corkscrew Esophagus; Distal Esophageal Spasm)

By

Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Reviewed/Revised Feb 2024
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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, injections of botulinum toxin, or sometimes surgery.

In esophageal spasm, the normal propulsive contractions that move food through the esophagus are replaced periodically by nonpropulsive contractions or excessive muscular contractions that do not move food through the esophagus.

How the Esophagus Works

As a person swallows, food moves from the mouth to the throat, also called the pharynx (1). The upper esophageal sphincter opens (2) so that food can enter the esophagus, where waves of muscular contractions, called peristalsis, propel the food downward (3). The food then passes through the diaphragm (4) and lower esophageal sphincter (5) and moves into the stomach.

How the Esophagus Works

The exact cause of esophageal spasm is not known but is suspected to be a nerve defect.

Symptoms of Esophageal Spasm

Sometimes, esophageal spasm does not cause any symptoms.

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 Angina Angina is temporary chest pain or a sensation of pressure that occurs while the heart muscle is not receiving enough oxygen. A person with angina usually has discomfort or pressure beneath the... read more (chest pain stemming from heart disease).

Diagnosis of Esophageal Spasm

  • Tests to rule out angina

  • Barium swallow x-rays

  • Manometry

Doctors do a barium swallow X-Ray Studies of the Digestive Tract X-rays often are used to evaluate digestive problems. Standard x-rays ( plain x-rays) can show some blockages or paralysis of the digestive tract, or abnormal air patterns in the abdominal cavity... read more . 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 Manometry Manometry is measurement of pressure within various parts of the digestive tract. People must not eat or drink anything after midnight before the test. In this test, a flexible tube with pressure... read more (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.

Treatment of Esophageal Spasm

  • Calcium channel blockers

  • Injections of botulinum toxin

  • Sometimes 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 medications such as nitroglycerin, long-acting nitrates, and medications with anticholinergic effects Anticholinergic: What Does It Mean? Anticholinergic: What Does It Mean? (such as dicyclomine) are less successful.

Rarely, a trial of botulinum toxin injections into the esophagus, lower esophageal sphincter, or both may be tried.

Some people have symptoms that are severe and difficult to treat. If medications do not help, 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.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Adalat, Adalat CC, Afeditab CR, Nifediac CC, Nifedical XL, Procardia, Procardia XL
Deponit, GONITRO , Minitran, Nitrek, Nitro Bid, Nitrodisc, Nitro-Dur, Nitrogard , Nitrol, Nitrolingual, NitroMist , Nitronal, Nitroquick, Nitrostat, Nitrotab, Nitro-Time, RECTIV, Transdermal-NTG, Tridil
Bentyl
NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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