What is esophageal spasm?

The esophagus is the tube that carries food from your mouth to your stomach. An esophageal spasm is when the muscles along the esophagus tighten in an irregular, painful way. Normally, the esophagus tightens in a coordinated manner to move food along and into the stomach. An esophageal spasm can prevent food from getting to the stomach. This leaves it stuck in the esophagus.

The cause of esophageal spasm is not known, although it is more common in people who have gastroesophageal reflux disease (GERD). In some people, very hot or very cold foods can trigger a spasm.

Most people with this condition have chest pain that may spread outward to the arms, back, neck, or jaw. This pain can feel similar to a heart attack. If you have chest pain, you should be evaluated by a doctor as soon as possible to rule out or treat cardiac disease.

Other symptoms include difficulty or inability to swallow food or liquid, pain with swallowing, the feeling that food is caught in the center of the chest, and a burning sensation in the chest (heartburn).

Treatment for esophageal spasm includes treating other conditions that may make esophageal spasms worse, such as gastroesophageal reflux disease (GERD). GERD is usually treated with changes to diet and lifestyle and medicines to reduce the amount of acid in the stomach.

Other treatment for esophageal spasm may include:

• Changing the foods you eat. Your doctor may tell you to eat certain foods and liquids to make swallowing easier.
• Medicines. If you can't have dilation or surgery, your doctor may suggest medicines, such as botulinum toxin, to relax the muscles in the esophagus.
• Surgery. Surgery is sometimes used in people who have a problem that affects the lower esophageal muscle (achalasia).

Your doctor can often find out the cause of esophageal spasm from your medical history by asking you a series of questions. These include questions about what foods or liquids trigger symptoms, where it feels like food gets stuck, other symptoms or conditions you may have, and whether you are taking medicines for them.

The diagnosis can be confirmed with tests, including esophagus tests (such as esophageal manometry) or a barium swallow. Esophageal manometry uses a small tube attached to instruments (transducers) that measure pressure. A barium swallow is done using X-rays.

Other tests may be done to find out whether chest pain may be caused by gastroesophageal reflux disease (GERD), the abnormal backflow (reflux) of food, stomach acid, and other digestive juices from the stomach into the esophagus.

• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• Treat other conditions that can make esophageal spasms worse, such as GERD.
• To treat GERD:
  • Your doctor may recommend an over-the-counter medicine. For mild or occasional indigestion, it may help to take antacids, such as Tums, Gaviscon, Mylanta, or Maalox. Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.
  • Your doctor also may recommend over-the-counter acid reducers, such as famotidine (Pepcid AC), cimetidine (Tagamet HB), or omeprazole (Prilosec).
  • Eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down.
  • Avoid foods that make your symptoms worse. These may include chocolate, mint, alcohol, pepper, spicy foods, high-fat foods, or drinks with caffeine in them, such as tea, coffee, colas, or energy drinks. If your symptoms are worse after you eat a certain food, you may want to stop eating it to see if your symptoms get better.
  • Do not smoke or chew tobacco.
  • If you have GERD symptoms at night, raise the head of your bed 6 to 8 inches. You can do this by putting the frame on blocks. Or you can place a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
  • Do not wear tight clothing around your middle.
  • Lose weight if you need to. Losing just 5 to 10 pounds can help.
• Ask your doctor about relaxation and controlled breathing exercises. These may help reduce symptoms.
• Avoid very hot or cold foods if they trigger esophageal spasms.

The cause of esophageal spasm is unknown. Many doctors believe it results from a disruption of the nerve activity that coordinates the swallowing action of the esophagus. In some people, very hot or very cold foods may trigger an episode.

Normally, the esophagus (the tube that connects the mouth and the stomach) contracts to move food from the mouth to the stomach. It does this with a regular, coordinated rhythm.

Esophageal spasm means that contractions of the esophagus are irregular, uncoordinated, and sometimes powerful. This condition may be called diffuse esophageal spasm, or DES. These spasms can prevent food from reaching the stomach. When this happens, the food gets stuck in the esophagus.

Sometimes the squeezing moves down the esophagus in a coordinated way, but it is very strong. This can be called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain.

Esophageal spasm is not common. Often, symptoms may suggest that esophageal spasm is the result of another condition. These may be a condition such as gastroesophageal reflux disease (GERD) or achalasia. Achalasia is a problem with the nervous system in which the muscles of the esophagus and the lower esophageal sphincter (LES) don't work right. Anxiety or panic attacks can also cause symptoms like this.