From the Guidelines
Refractory esophageal spasms can be treated with medical therapy, botulinum toxin injections, and endoscopic dilation.
Treatment Options
- Medical therapy is often the first line of treatment for refractory esophageal spasms, although the specific medications and dosages are not specified in the provided evidence.
- Botulinum toxin injections have been suggested as a less invasive alternative to per-oral endoscopic myotomy (POEM) 1.
- Endoscopic dilation is also a viable option for treating refractory esophageal spasms, and should be considered before POEM in selected cases 1.
Considerations
It is essential to make a distinction between manometric and clinically relevant diagnoses of esophageal motility disorders, and to exclude other conditions such as gastroesophageal reflux disease (GERD) through confirmatory testing like impedance planimetry, timed barium esophagram, and pH study 1.
POEM Consideration
POEM may be considered in very selected cases where less invasive alternatives have been exhausted, although its role in treating non-achalasia spastic motility disorders like refractory esophageal spasms is not well-defined 1.
From the Research
Treatment Options for Refractory Esophageal Spasms
The treatment of refractory esophageal spasms can be challenging, and various options are available. These include:
- Medical therapy:
- Endoscopic procedures:
- Surgical therapy:
Specific Considerations for Refractory Cases
In cases where esophageal spasms are refractory to initial treatments, more invasive approaches may be considered. These include:
- Surgery, such as esophageal myotomy, which may be considered a last resort 6
- Alternative treatment approaches, such as pneumatic esophageal dilation, which may be effective in select cases 5
- The use of botulinum toxin injections, which may be reserved for patients who do not respond to other treatments 2