From the Guidelines
Esophageal spasms should be treated with a combination of lifestyle modifications and medications, starting with proton pump inhibitors like omeprazole (20-40mg daily) or pantoprazole (40mg daily) to reduce acid reflux, and calcium channel blockers such as nifedipine (10-30mg daily) or diltiazem (30-90mg daily) to relax the esophageal muscles, as these approaches have been shown to be effective in managing symptoms and improving quality of life 1.
Treatment Approach
When managing esophageal spasms, it's crucial to consider the potential underlying causes, including autoimmune conditions, eosinophilic esophagitis, and infectious etiologies like Chagas disease or COVID-19, as identified in recent studies 1. The treatment plan should be tailored to address the specific cause and symptoms of the patient.
- Lifestyle modifications are essential and include avoiding trigger foods, eating smaller meals, and reducing stress.
- Medications such as proton pump inhibitors and calcium channel blockers are often effective in reducing symptoms.
- For severe cases, nitrates like isosorbide dinitrate (5-10mg as needed) may provide relief, and peppermint oil (0.2-0.4ml in water before meals) has muscle-relaxing properties that some patients find helpful.
Diagnostic Considerations
Given the complex and varied presentations of esophageal spasms, diagnostic considerations should include:
- Upper endoscopy with biopsies to rule out other diagnoses and assess for esophageal involvement of bullous dermatoses or autoimmune conditions.
- High-resolution esophageal manometry to evaluate esophageal function and identify potential motility disorders.
- Timed barium esophagram with pill to assess esophageal emptying and rule out structural abnormalities.
Important Considerations
Patients with esophageal spasms should be aware of the potential for severe chest pain that can mimic symptoms of a heart attack, and thus, should seek immediate medical attention if symptoms are severe. Additionally, the association between esophageal spasms and conditions like eosinophilic esophagitis or achalasia highlights the need for a comprehensive diagnostic approach to ensure appropriate management and improve patient outcomes 1.
From the Research
Definition and Diagnosis of Esophagus Spasm
- Esophagus spasm, also known as esophageal spasm, is a condition characterized by abnormal contractions of the esophagus, which can cause chest pain and dysphagia 2, 3, 4, 5.
- The diagnosis of esophagus spasm is typically made using esophageal manometry, which measures the contractions of the esophagus 2, 3, 4, 5.
- High-resolution manometry is a newer technique that has been used to diagnose esophagus spasm, particularly distal esophageal spasm (DES) 3, 5.
Treatment Options for Esophagus Spasm
- Treatment options for esophagus spasm include medications such as nitrates, calcium channel blockers, and tricyclic antidepressants or serotonin reuptake inhibitors 2, 4.
- Botulinum toxin injections, dilatations, and myotomies have also been used to treat esophagus spasm, particularly in patients who do not respond to medical therapy 3, 4, 6.
- Per-oral endoscopic myotomy (POEM) is a newer treatment option that has been shown to be effective in relieving dysphagia in patients with esophagus spasm, particularly those with hypercontractile esophagus (HE) 6.
Specific Considerations for Distal Esophageal Spasm (DES)
- DES is a rare motility disorder that presents with nonobstructive dysphagia and noncardiac chest pain 3, 5.
- The diagnosis of DES is made using high-resolution manometry, which shows premature or simultaneous contractions intermixed with normal peristalsis 3, 5.
- Treatment options for DES include botulinum toxin injections, POEM, and medical therapy with nitrates or calcium channel blockers 3, 5, 6.
Hypercontractile Esophagus (HE)
- HE is a heterogeneous major motility disorder characterized by hypercontractile peristaltic sequences on esophageal high-resolution manometry (HRM) 6.
- HE can manifest with dysphagia and chest pain, and the pathophysiology may entail an excessive cholinergic drive with temporal asynchrony of circular and longitudinal muscle contractions 6.
- Treatment options for HE include an empiric trial of a proton pump inhibitor, calcium channel blockers, nitrates, and phosphodiesterase inhibitors, as well as endoscopic treatment with botulinum toxin injection or POEM 6.