From the Guidelines
Esophageal spasms typically cause chest pain that feels like squeezing or tightness, which can be confused with heart pain, and are often accompanied by difficulty swallowing, painful swallowing, and regurgitation of food or liquids. Common symptoms of esophageal spasms include:
- Difficulty swallowing (dysphagia)
- Painful swallowing (odynophagia)
- Feeling like food is stuck in your throat
- Heartburn
- Regurgitation of food or liquids These symptoms occur because the normal wave-like contractions of the esophagus become uncoordinated or excessively forceful, disrupting the smooth passage of food and liquids 1. According to the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline, gastrointestinal pain, including esophageal spasms, may result from stimulation of chemoreceptors by acid or hyperosmolar substances, of mechanoreceptors by abnormal contraction or distention, or of thermoreceptors 1.
Treatment and Management
Treatment for esophageal spasms typically includes medications like calcium channel blockers (such as diltiazem), muscle relaxants, or acid-reducing medications (like omeprazole 20mg daily) 1. Lifestyle changes that may help include avoiding trigger foods, eating smaller meals, reducing stress, and elevating the head of your bed if reflux is present. In some cases, oesophageal dilatation may be indicated to alleviate symptoms and permit maintenance of oral nutrition 1. However, the most recent and highest quality study suggests that less invasive alternatives, such as medical therapy, botulinum toxin injections, and endoscopic dilation, should be exhausted before consideration of per-oral endoscopic myotomy (POEM) in very selected cases 1.
Importance of Medical Attention
If you experience symptoms of esophageal spasms, especially chest pain, it is crucial to seek medical attention promptly to rule out heart problems. A thorough evaluation, including diagnostic tests such as impedance planimetry, timed barium esophagram, and pH study, may be necessary to confirm the diagnosis and exclude other conditions like gastroesophageal reflux disease (GERD) 1.
From the Research
Esophageal Spasm Symptoms
- Esophageal spasm is a common empiric diagnosis clinically applied to patients with unexplained chest pain 2
- Symptoms of esophageal spasm include nonobstructive dysphagia and noncardiac chest pain 3, 4
- Diffuse esophageal spasm (DES) is characterized by symptoms such as chest pain and dysphagia 5
Diagnosis of Esophageal Spasm
- Diagnosis of esophageal spasm is made when >10% of the wet swallows have simultaneous and/or premature contractions intermixed with normal peristalsis 3
- High-resolution manometry is used to diagnose distal esophageal spasm, with evidence of at least 20% premature contractions in the setting of a normal lower esophageal sphincter relaxation 4
- Functional lumen imaging probe is a growing diagnostic modality that gives a more complete picture of esophageal motility 4
Treatment of Esophageal Spasm
- Treatment of esophageal spasm is difficult, and an approach beginning with the least invasive intervention is proposed 3
- Pharmacologic treatment options include nitrates, calcium channel blockers, phosphodiesterase 5 inhibitors, and tricyclic antidepressants 2, 6
- Endoscopic procedures such as botulinum toxin A injection and peroral endoscopic myotomy may be beneficial for patients with esophageal hypermotility disorders 6
- Surgery, such as Heller myotomy, may be considered for patients with achalasia or esophagogastric junction outflow obstruction 6