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.
The esophagus Throat and Esophagus The throat (pharynx) lies behind and below the mouth. When food and fluids leave the mouth, they pass through the throat. Swallowing of food and fluids begins voluntarily and continues automatically... read more is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus Overview of the Esophagus The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. Food does not just fall through the esophagus into the stomach. The walls of the esophagus propel food to... read more .)
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
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.
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.
When it does cause symptoms, muscle spasms throughout the esophagus typically are felt as chest pain Chest Pain Chest pain is a very common complaint. Pain may be sharp or dull, although some people with a chest disorder describe their sensation as discomfort, tightness, pressure, gas, burning, or aching... read more under the breastbone coinciding with difficulty swallowing Difficulty Swallowing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become... read more (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 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
Because the chest pain of esophageal spasm is similar to that of 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 resulting from poor blood flow to the heart), doctors do tests to rule out angina. Tests may include electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. This record, the electrocardiogram (also known as an ECG)... read more (ECG), exercise stress testing Stress Testing Stressing the heart (by exercise or by use of stimulant drugs to make the heart beat faster and more forcibly) can help identify coronary artery disease. In coronary artery disease, blood flow... read more , or other tests.
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
Sometimes injections of botulinum toxin
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 Anticholinergic: What Does It Mean? (such as dicyclomine) are less successful.
If drugs do not help, 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. 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|