From the Guidelines
Esophageal spasms are characterized by sudden, powerful, and uncoordinated contractions of the esophagus, with symptoms including chest pain, difficulty swallowing, painful swallowing, and a feeling that food is stuck in the throat or chest, as noted in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1. The main symptoms of esophageal spasms include:
- Chest pain that can be severe and may mimic a heart attack
- Difficulty swallowing (dysphagia)
- Painful swallowing (odynophagia)
- A feeling that food is stuck in the throat or chest
- Regurgitation of food or liquids
- Heartburn
- A sensation of food moving back up the esophagus after swallowing These symptoms often occur during or after eating and may be triggered by very hot or cold foods and liquids, or by stress, as suggested by the British Society of Gastroenterology guidelines for oesophageal manometry and oesophageal reflux monitoring 1. The pain from esophageal spasms typically lasts for minutes to hours and can radiate to the back, neck, jaw, or arms. Some patients may also experience weight loss due to eating difficulties. If you experience these symptoms, especially severe chest pain, seek medical attention promptly to rule out cardiac issues, as recommended by the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1. Treatment typically involves medications like calcium channel blockers, nitrates, or low-dose antidepressants to relax the esophageal muscles, along with proton pump inhibitors if acid reflux is contributing to symptoms. Avoiding trigger foods, eating smaller meals, and stress management techniques can also help reduce the frequency and severity of spasms. When an esophageal cause of chest pain is suspected, upper endoscopy should be considered, and symptoms and signs that merit early evaluation include dysphagia, odynophagia, gastrointestinal bleeding, unexplained iron deficiency anemia, weight loss, and recurrent vomiting, as noted in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1.
From the Research
Esophagus Spasm Signs and Symptoms
- Dysphagia (difficulty swallowing) is a common symptom of esophageal spasm, as noted in studies 2, 3, 4
- Chest pain is another frequent symptom, which can be frightening for patients and may lead to further investigation to rule out cardiac disease 3, 5
- Regurgitation and heartburn may also occur in patients with esophageal spasm 4
- Unintentional weight loss can be a consequence of esophageal spasm, particularly if dysphagia is severe 4
Diagnosis and Manometric Features
- Esophageal spasm is typically diagnosed using high-resolution manometry, which can help identify abnormal contractions in the esophagus 2, 3
- The Chicago Classification is used to standardize the diagnosis of esophageal motility disorders, including esophageal spasm 2
- Video fluoroscopic swallow or gastroscopy testing may also be used to support the diagnosis, although manometry is the primary diagnostic tool 2
Treatment Options
- Botulinum toxin injection has been shown to be effective in reducing symptoms of esophageal spasm, including dysphagia and chest pain 3, 4
- Peroral endoscopic myotomy is a promising therapeutic approach, although its effectiveness may vary depending on the specific condition being treated 2, 3
- Proton pump inhibitors, antidepressants, and cognitive behavioral therapy may also be useful in managing symptoms of esophageal spasm, particularly if gastroesophageal reflux disease or esophageal hypersensitivity are contributing factors 5