Summary about Disease
Esophageal spasm is a condition characterized by sudden, uncoordinated contractions of the muscles in the esophagus, the tube that carries food from the mouth to the stomach. These spasms can cause chest pain, often mistaken for heart problems, and difficulty swallowing (dysphagia). There are two main types: Diffuse Esophageal Spasm (DES), where contractions are uncoordinated and may occur simultaneously in different parts of the esophagus, and Nutcracker Esophagus (also known as Hypercontractile Esophagus), where contractions are coordinated but are excessively strong.
Symptoms
Chest pain (often severe and squeezing)
Difficulty swallowing (dysphagia), especially with liquids or solids
Feeling of food getting stuck in the chest
Heartburn
Regurgitation of food or liquids
Pain in the back, neck, or jaw (less common)
Causes
The exact cause of esophageal spasm is often unknown. However, several factors may contribute:
Abnormal nerve function: Problems with the nerves that control esophageal muscle contractions.
Acid reflux (GERD): Stomach acid backing up into the esophagus can irritate the lining and trigger spasms.
Hot or cold foods or liquids: Extreme temperatures can sometimes trigger spasms.
Stress or anxiety: Emotional stress can exacerbate symptoms.
Hiatal hernia: When the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm)
Medicine Used
Calcium Channel Blockers (e.g., diltiazem, nifedipine): Relax esophageal muscles.
Nitrates (e.g., isosorbide dinitrate, nitroglycerin): Relax esophageal muscles; often used for acute episodes.
Tricyclic Antidepressants (e.g., amitriptyline, imipramine): Reduce pain perception and may help regulate nerve function.
Phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil): Can relax smooth muscles in the esophagus.
Proton Pump Inhibitors (PPIs) (e.g., omeprazole, lansoprazole): Reduce stomach acid production, helpful if GERD is a contributing factor.
Botulinum Toxin (Botox) injections: Injected into the esophageal muscles to paralyze them and reduce spasms.
Pain relievers: Over-the-counter or prescription pain relievers may be used to manage pain.
Is Communicable
No, esophageal spasm is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
Identify and avoid triggers: Keep a food diary to identify foods or situations that trigger spasms.
Eat small, frequent meals: This can reduce the burden on the esophagus.
Avoid extreme temperatures: Avoid very hot or cold foods and beverages.
Manage stress: Practice relaxation techniques such as deep breathing, meditation, or yoga.
Elevate the head of the bed: This can help reduce acid reflux, especially at night.
Avoid lying down after eating: Wait at least 2-3 hours after eating before lying down.
Limit caffeine and alcohol: These substances can worsen esophageal symptoms.
Quit smoking: Smoking can irritate the esophagus and worsen reflux.
How long does an outbreak last?
The duration of esophageal spasm outbreaks varies. An individual episode of spasm can last from a few minutes to several hours. Some people experience infrequent episodes, while others have more frequent or chronic symptoms. There is no set timeframe for how long outbreaks last overall. The course of the condition is unpredictable, and symptoms can wax and wane.
How is it diagnosed?
Medical history and physical exam: Doctor will ask about your symptoms and medical history.
Barium swallow: X-ray of the esophagus after swallowing barium, which helps visualize the esophageal lining and contractions.
Esophageal manometry: Measures the pressure and pattern of muscle contractions in the esophagus. This is the most important test for diagnosing esophageal spasm.
Upper endoscopy: A thin, flexible tube with a camera is inserted into the esophagus to visualize the lining and rule out other conditions.
Esophageal pH monitoring: Measures the amount of acid refluxing into the esophagus.
Timeline of Symptoms
The timeline of symptoms can vary greatly among individuals. Symptoms may appear suddenly and unexpectedly. Some individuals experience infrequent, isolated episodes. Others have clusters of symptoms that occur over days or weeks, followed by periods of remission. Chronic symptoms can persist for months or even years, with periods of increased and decreased severity. The timeline is often unpredictable.
Important Considerations
Chest pain from esophageal spasm can mimic heart attack pain. Seek immediate medical attention if you experience new or severe chest pain.
Esophageal spasm can significantly impact quality of life. Effective management of symptoms is important.
Treatment is often aimed at symptom relief, as there is no cure for esophageal spasm.
It is important to rule out other conditions with similar symptoms, such as GERD, achalasia, and esophageal cancer.
Psychological support or counseling may be helpful for managing stress and anxiety related to the condition.