Esophageal spasm

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Esophageal spasm
Other namesOesophageal spasm
Specialty Gastroenterology
Differential diagnosis Achalasia, angina, scleroderma, esophageal cancer, esophagitis, eosinophilic esophagitis [1]

Esophageal spasm is a disorder of motility of the esophagus. [2]

Contents

There are two types of esophageal spasm: [2]

Both conditions are linked to gastroesophageal reflux disease (GERD). [2] DES and nutcracker esophagus present similarly and can may require esophageal manometry for differentiation. [3]

When the coordinated muscle contraction are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. These spasms can prevent food from reaching the stomach where food gets stuck in the esophagus. At other times the coordinated muscle contraction is very powerful, which is called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain. [4]

Signs and symptoms

The symptoms may include trouble swallowing, regurgitation, chest pain, [5] heartburn, [6] globus pharyngeus (which is a feeling that something is stuck in the throat) or a dry cough. [7]

Causes

It is not clear what causes esophageal spasms. [1] [7] Sometimes esophageal spasms start when someone eats hot or cold foods or drinks. However, they can also occur without eating or drinking. [7] The increased release of acetylcholine may also be a factor, but the triggering event is not known. [6] Spasms may also be the result of a food intolerance.

Diagnosis

The diagnosis is generally confirmed by esophageal manometry. [2] DES is present when more than a fifth of swallows results in distal esophageal contractions. [2] NE is present if the average strength of the contractions of the distal esophagus is greater than 180 mmHg but the contraction of the esophagus is otherwise normal. [2]

Differential diagnosis

Often, symptoms that may suggest esophageal spasm are the result of another condition such as food intolerance, gastroesophageal reflux disease (GERD), achalasia or eosinophilic esophagitis. [4] [8] The symptoms can commonly be mistaken as heart palpitations.

Treatment

Since esophageal spasms are often associated with other disorders, management in these cases involve attempts to correct the underlying problem. Medications may include use of calcium channel blockers (CCBs) and nitrates. Tricyclic antidepressants (TCA) and sildenafil can be used as alternative treatment options. If caused by food allergy, an elimination diet may be necessary.

There have been reports of treatment of distal esophageal spasm in 8 patients using low amounts of peppermint oil (five drops of peppermint oil in 10ml of water), [9] and a report of treatment of an elderly patient with the same diagnosis. [10]

Nitroglycerin has also been found effective at treating acute esophageal spasms, by increasing nitric oxide (NO) levels it acts as a smooth muscle relaxant which relaxes muscle cells and lowers pressure in the lower esophageal sphincter, reducing the intense, uncoordinated contractions in the esophagus and easing chest pain. [11] It is often used to treat esophageal spasms associated with eosinophilic esophagitis and Gastroesophageal reflux disease (GERD), although it appears to be less effective at treating spasms in those with GERD. [12] [13]

Procedures

If medical therapy fails either botulinum toxin injection or surgical myotomy may be tried in distal esophageal spasms. [14]

Epidemiology

Distal esophageal spasm is rare. [14]

References

  1. 1 2 Goel, S; Nookala, V (January 2025). "Diffuse Esophageal Spasm". StatPearls. StatPearls Publishing. PMID   31082150.
  2. 1 2 3 4 5 6 "Oesophageal Spasm". EMIS Health . Retrieved 2015-11-15.
  3. ↑ Lightdale, Charles J. (2009). The Foregut: Function-dysfunction. John Libbey Eurotext. p. 50. ISBN   978-2-7420-0721-9.
  4. 1 2 "Esophageal Spasm – Topic Overview". WebMD . Retrieved 2015-11-15.
  5. ↑ "Esophageal Spasm". WebMD . Retrieved 2015-11-15.
  6. 1 2 "Esophageal Spasm Clinical Presentation – History". WebMD . Retrieved 2015-11-15.
  7. 1 2 3 "Esophageal Spasms & Strictures". Cleveland Clinic . Retrieved 2015-11-15.
  8. ↑ Nurko, Samuel; Rosen, Rachel (January 2008). "Esophageal Dysmotility in Patients Who Have Eosinophilic Esophagitis". Gastrointestinal Endoscopy Clinics of North America. 18 (1). Elsevier Inc.: 73–89. doi:10.1016/j.giec.2007.09.006. ISSN   1558-1950. PMC   3001401 . PMID   18061103 . Retrieved 30 December 2025.
  9. ↑ Pimentel, M.; Bonorris, G. G.; Chow, E. J.; Lin, H. C. (July 2001). "Peppermint oil improves the manometric findings in diffuse esophageal spasm". Journal of Clinical Gastroenterology. 33 (1): 27–31. doi:10.1097/00004836-200107000-00007. ISSN   0192-0790. PMID   11418786. S2CID   46427292.
  10. ↑ Parvataneni, Swetha; Vemuri-Reddy, Sireesha (2020-03-06). "Role of Peppermint Oil in Diffuse Esophageal Spasm in the Geriatric Population". Cureus. 12 (3) e7192. doi: 10.7759/cureus.7192 . ISSN   2168-8184. PMC   7137643 . PMID   32269872.
  11. ↑ Orlando, Roy C.; Bozymski, Eugene M. (5 July 1973). "Clinical and Manometric Effects of Nitroglycerin in Diffuse Esophageal Spasm". New England Journal of Medicine . 289 (1). Massachusetts Medical Society: 23–25. doi:10.1056/NEJM197307052890106. ISSN   1533-4406. PMID   4196712 . Retrieved 30 December 2025.
  12. ↑ Swamy, N (January 1977). "Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites". Gastroenterology. 72 (1). Elsevier Inc.: 23–7. PMID   401445 . Retrieved 30 December 2025.
  13. ↑ Kikendall, Walter J.; Mellow, Mark H. (October 1980). "Effect of sublingual nitroglycerin and long-acting nitrate preparations on esophageal motility". Gastroenterology. 79 (4). Walter Reed Army Medical Center, Washington D.C.: Elsevier Inc.: 703–706. doi:10.1016/0016-5085(80)90248-6. ISSN   0016-5085 . Retrieved 30 December 2025.
  14. 1 2 Roman, S; Kahrilas, PJ (July 2015). "Distal esophageal spasm". Current Opinion in Gastroenterology. 31 (4): 328–33. doi:10.1097/MOG.0000000000000187. PMID   26039725. S2CID   25972582.
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