From the Guidelines
The initial management for esophageal spasm should focus on lifestyle modifications and medications that relax the smooth muscle of the esophagus, with calcium channel blockers like nifedipine or diltiazem being first-line treatments. Patients should avoid trigger foods such as hot or cold beverages, spicy foods, alcohol, and caffeine. Eating smaller, more frequent meals and remaining upright for 2-3 hours after eating can help reduce symptoms.
Key Lifestyle Modifications
- Avoiding trigger foods
- Eating smaller, more frequent meals
- Remaining upright for 2-3 hours after eating
First-Line Medications
- Calcium channel blockers like nifedipine (10-30 mg daily) or diltiazem (30-90 mg three to four times daily)
- Peppermint oil (0.2 ml in water before meals) to reduce muscle contractions
- Nitrates such as isosorbide dinitrate (5-10 mg sublingually as needed) for acute episodes
- Low-dose antidepressants like amitriptyline (10-50 mg at bedtime) to modulate pain perception
- Proton pump inhibitors like omeprazole (20-40 mg daily) if there is concurrent acid reflux These treatments work by decreasing the hypercontractility of esophageal muscles and reducing the visceral hypersensitivity that contributes to pain perception in esophageal spasm, as supported by recent clinical practice updates 1. High-resolution manometry, as mentioned in earlier guidelines 1, can be useful in evaluating patients with suspected esophageal disorders, including those with esophageal spasm, but the initial approach should prioritize these lifestyle and medication adjustments.
From the Research
Initial Management for Esophageal Spasm
The initial management for esophageal spasm involves several treatment options, including:
- Pharmacologic agents that reduce esophageal contractile force, such as anticholinergic agents, nitrates, and calcium antagonists 2
- Botulinum toxin injection, which has been shown to be an effective treatment for patients with symptoms caused by diffuse esophageal spasm 3, 4
- Long acting nitrites, which can be used to manage diffuse esophageal spasm, especially in patients without gastroesophageal reflux 5
Treatment Options
Some specific treatment options for esophageal spasm include:
- Diltiazem, a calcium antagonist that can offer relief in selected individual patients suffering from diffuse esophageal spasm, although it did not yield a significant improvement of symptoms in one study 6
- Botulinum toxin injection, which has been shown to improve symptoms and esophageal transit time in patients with diffuse esophageal spasm 3, 4
- Nitroglycerine and long acting nitrites, which can be effective in managing diffuse esophageal spasm, especially in patients without gastroesophageal reflux 5
Considerations
When considering treatment options for esophageal spasm, it is important to note that:
- The clinical benefit of medical treatment of esophageal motility disorders is rather disappointing, and further understanding of esophageal pathophysiology is needed to develop effective treatments 2
- Botulinum toxin injection is a promising therapeutic option for achalasia and diffuse esophageal spasm, but more studies are needed to evaluate its effectiveness 3, 4, 2