From the Research
Esophageal spasm treatment should begin with lifestyle modifications and medications, prioritizing the reduction of acid reflux and relaxation of esophageal muscles, as these approaches have shown to be effective in managing symptoms and improving quality of life. Patients should avoid trigger foods (spicy, acidic, very hot or cold items), eat smaller meals, and remain upright for 2-3 hours after eating. First-line medications include proton pump inhibitors like omeprazole (20-40mg daily) or pantoprazole (40mg daily) to reduce acid reflux that can trigger spasms, as suggested by 1. Calcium channel blockers such as nifedipine (10-30mg daily) or diltiazem (30-90mg daily) help relax the esophageal muscles.
For persistent symptoms, low-dose antidepressants like amitriptyline (10-50mg at bedtime) can help modulate pain perception, as noted in 2. The use of botulinum toxin injections into the lower esophageal sphincter may provide temporary relief lasting 3-6 months, but this should be reserved for patients who do not respond to initial treatments, as recommended by 1. In severe cases unresponsive to other treatments, surgical interventions like peroral endoscopic myotomy (POEM) or laparoscopic Heller myotomy may be considered, although these are more invasive and should be approached with caution.
Key considerations in the treatment of esophageal spasm include:
- Reducing acid reflux through lifestyle modifications and proton pump inhibitors
- Relaxing esophageal muscles with calcium channel blockers
- Modulating pain perception with low-dose antidepressants for persistent symptoms
- Reserving more invasive treatments, such as botulinum toxin injections and surgical interventions, for severe or unresponsive cases, as discussed in 3 and 1.