Esophageal spasms

Overview

Esophageal spasms are painful contractions within the muscular tube connecting your mouth and stomach. This tube is called the esophagus. Esophageal spasms can feel like sudden, severe chest pain that lasts from a few minutes to hours. Some people may mistake it for heart pain, also called angina.

Esophageal spasms typically occur only occasionally and might not need treatment. But sometimes the spasms are frequent and can prevent food and liquids from traveling through the esophagus. If esophageal spasms interfere with your ability to eat or drink, treatments are available.

Symptoms

Symptoms of esophageal spasms include:

• Squeezing pain in your chest. The pain is often intense, and you might mistake it for heart pain, also known as angina.
• Difficulty swallowing solids and liquids, sometimes related to swallowing specific substances. Red wine or extremely hot or cold liquids are more common culprits.
• The feeling that an object is stuck in your throat.
• The return of food and liquids back up your esophagus, also called regurgitation.

When to see a doctor

The squeezing chest pain associated with esophageal spasms also can be caused by a heart attack. If you experience squeezing chest pain, seek immediate medical care.

Causes

It's not clear what causes esophageal spasms. However, they appear to be related to atypical functioning of nerves that control the muscles you use when you swallow.

A healthy esophagus usually moves food into your stomach through a series of coordinated muscle contractions. Esophageal spasms make it difficult for the muscles in the walls of your lower esophagus to coordinate in order to move food to your stomach.

There are two types of esophageal spasms — distal esophageal spasm and hypercontractile esophagus, also referred to as jackhammer esophagus.

Risk factors

There are no known risk factors for esophageal spasms.

Diagnosis

Your health care provider might recommend:

• Esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow, the coordination and force exerted by the esophagus muscles, and how well your lower esophageal sphincter relaxes or opens during a swallow.
• X-rays of your upper digestive system, also called an esophagram. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your provider to see a silhouette of your esophagus, stomach and upper intestine.
• Upper endoscopy. Your provider inserts a thin, flexible tube equipped with a light and camera down your throat to examine the inside of your esophagus and stomach. This instrument is called an endoscope. Endoscopy also can be used to collect a sample of tissue to be tested for other esophageal diseases. This tissue sample is known as a biopsy.

Treatment

Treatment depends on the frequency and severity of your esophageal spasms.

If your spasms are occasional, your provider might first recommend avoiding extremely hot or cold foods to see if that relieves your symptoms.

If your spasms make it difficult to eat or drink, your provider might recommend:

• Managing any underlying conditions. Esophageal spasms are sometimes associated with conditions such as heartburn or gastroesophageal reflux disease (GERD). Your provider might recommend a proton pump inhibitor to treat GERD. Sometimes an antidepressant, such as imipramine (Tofranil), may be prescribed. This medicine may help reduce the sensation of pain in the esophagus.
• Medicines to relax your swallowing muscles. Peppermint oil, onabotulinumtoxinA (Botox) injections or calcium channel blockers, such as diltiazem (Cardizem, Tiazac, others), can make spasms less severe.
• Surgery (myotomy). If medicine doesn't work, your provider might recommend a procedure that involves cutting the muscle at the lower end of the esophagus. This procedure, called a myotomy, can help weaken esophageal contractions. Long-term studies of this approach aren't available, so myotomy generally isn't recommended for esophageal spasms. However, it might be considered if other treatments don't work.
• Peroral endoscopic myotomy (POEM). The POEM procedure is minimally invasive. This recent technique involves inserting an endoscope through your mouth and down your throat. This allows a surgeon to make an incision in the inside lining of your esophagus. Then, as in standard myotomy, the surgeon cuts the muscle at the lower end of the esophagus. Like standard myotomy, POEM is usually considered only if other treatments don't work.

Lifestyle and home remedies

To help you cope with occasional esophageal spasms, try to:

• Avoid your triggers. Make a list of foods and beverages that cause your esophageal spasms.
• Choose food that is warm or cool. Let foods and drinks that are very hot or very cold sit for a bit before eating or drinking them.
• Suck a peppermint lozenge. Peppermint oil is a smooth muscle relaxant and might help ease esophageal spasms. Place the peppermint lozenge under your tongue.

Preparing for an appointment

You may be referred to a health care provider who specializes in the digestive system, also called a gastroenterologist.

What you can do

• Be aware of any pre-appointment restrictions, such as fasting before your appointment.
• Write down your symptoms, including any that may seem unrelated to the reason you scheduled the appointment.
• Write down any triggers to your symptoms, such as specific foods.
• Make a list of all your medications, vitamins and supplements.
• Write down your key medical information, including other conditions.
• Write down key personal information, including any recent changes or stressors in your life.
• Write down questions to ask during your appointment.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.

Questions to ask your doctor

• What's the most likely cause of my symptoms?
• What tests do I need? Is there any special preparation for them?
• Is my condition likely temporary or chronic?
• What treatments are available?
• What types of foods are likely to make my symptoms worse?
• I have other health problems. How can I best manage these conditions together?

In addition to the questions that you've prepared, don't hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

• When did you begin experiencing symptoms? How severe are they?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve or worsen your symptoms?
• Does exertion bring on your chest pain?
• Is your chest pain associated with arm or jaw pain, shortness of breath, or nausea?
• Are your symptoms related to eating? Are they triggered by any particular food or type of food?
• Do you experience symptoms of heartburn after eating, such as a burning sensation in your chest or an acid taste in your mouth?
• Do you ever wake up during the night with heartburn, chest pain or an acid taste in your mouth?
• Do you have difficulty swallowing food, or have you had to change your diet to avoid difficulty swallowing?