What is an esophageal spasm?
The esophagus runs from the mouth to the stomach and is part of a person's digestive system. It moves food from the throat to the stomach by contracting in a coordinated manner.
The esophagus is the tube that carries the food and drink a person ingests into their stomach. It is around 10 inches in length and has muscular walls lined with mucous membranes.
For some, esophageal spasms happen frequently and interfere with the ability to eat and drink normally. When this is the case, treatment is usually required.
- Most people tend to experience esophageal spasms infrequently.
- Those between the ages of 60 and 80 are more likely to have them.
- A doctor can diagnose the condition by performing several tests.
Causes of esophageal spasm
Esophageal spasms occur in the esophagus, a tube running from the mouth to the stomach.
There is no definitive reason why esophageal spasms occur. It is thought that a problem with the nerves controlling the esophageal muscles may be one cause.
Many people find that there are specific triggers that prompt esophageal spasms. These include:
- food and drink, such as red wine or spicy food
- temperature of food, being either too hot or too cold
- medication and treatment for cancer, including radiation or surgery on the esophagus
- stress, depression, or anxiety
- gastroesophageal reflux disease (GERD), if scarring or narrowing of the esophagus occurs
Esophageal spasms are divided into two categories:
Diffuse esophageal spasms: These usually make a person regurgitate food or drink. They happen only occasionally and can be painful.
Nutcracker esophagus: Where painful spasms occur, but no food or liquid is regurgitated. They can make it hard for a person to swallow.
What are the risk factors?
While esophageal spasms are rare, there are certain risk factors which may make a person more susceptible to them.
Risk factors include:
- having high blood pressure
- experiencing times of anxiety or depression
- consuming trigger foods or drinks, such as red wine or very hot or cold food
- having gastroesophageal reflux disease (GERD)
People between the ages of 60 and 80 are more likely to experience esophageal spasms.
Symptoms and when to see a doctor
Potential symptoms of esophageal spasms include chest pain and heartburn.
People who experience esophageal spasms may have the following symptoms:
- severe chest pain, as if the chest is being squeezed or the person has a heart attack
- difficulty swallowing
- feeling as though an object is stuck in the throat or chest
- regurgitation of food or drink
It is essential to seek advice from a doctor if the above symptoms occur or a person believes they are experiencing an esophageal spasm. This is because it is vital for a doctor to rule out any severe or life-threatening conditions with similar systems, such as angina or heart attack.
A doctor can diagnose esophageal spasm by performing several tests. Initially, they are likely to rule out any more serious conditions, such as angina, by performing a cardiac test, for example, an EKG.
Other tests include:
- Esophageal manometry: Muscle contractions of the esophagus are measured while water is swallowed.
- Barium swallow: A person is asked to drink a contrast liquid, and an X-ray is then taken. The liquid helps doctors to get a better view of the esophagus.
- Endoscopy: Performing an endoscopy involves a thin tube being put into a person's throat. The tube has a light and camera on it that allows a doctor to see inside of the esophagus.
- Esophageal pH monitoring: A test that measures the pH balance of the esophagus to show if a person has acid reflux.
What are the treatment options?
Eating smaller meals more frequently, and increasing fiber intake, may help to treat esophageal spasms.
It is essential to find out which type of esophageal spasm a person has to be able to treat them correctly.
Diffuse esophageal spasms can be treated by assessing what foods and drinks are triggers and eliminating these from a person's diet.
Keeping a food diary of what is consumed, as well as the temperature and portion size, will help decipher where changes to diet should be made.
Other diet and lifestyle changes which could help ease esophageal spasms include:
- eating smaller, more frequent meals, and avoiding large portions
- increasing daily fiber intake
- quitting smoking
- losing weight if necessary
- eating earlier in the evening
- reducing or eliminating alcohol
- wearing loose clothing
Natural remedies can also be effective treatments for esophageal spasms.
Standardized deglycyrrhizinated licorice (DGL) extract, which is available in powder or chewable tablet forms, can be taken before and after meals to reduce spasms.
Peppermint oil can also be beneficial to people who experience esophageal spasms. Making a solution of peppermint oil and water or sucking on a peppermint lozenge can help to reduce symptoms.
A doctor may also prescribe medication to help when someone has these digestion spasms.
People with GERD may be given a proton pump inhibitor or an H2 blocker. However, these are not without side effects, and some research suggests proton pump inhibitors, used over an extended period, could cause kidney disease.
If anxiety or depression is a trigger for esophageal spasms, antidepressants may be prescribed.
Surgery is another option for more severe cases where medication has not helped.
Peroral endoscopic myotomy (POEM) is a procedure where the surgeon inserts an endoscope through a person's mouth, cutting the muscle at the bottom of the esophagus, which should result in contractions becoming less severe.
Alternatively, Heller myotomy is a different surgery, which may help people with esophageal spasms.
In this laparoscopic surgery, the esophageal sphincter muscle is cut, allowing food and drink to pass to the stomach more easily.
Prevention and outlook
Eliminating the foods that trigger esophageal spasms may reduce how often a person experiences them. Taking prescribed medication and making dietary and lifestyle changes can also be beneficial.
An underlying condition, such as GERD or depression, may be the cause of esophageal spasms, in which case these should be treated to relieve symptoms.
Seeing a doctor if esophageal spasms occur, helps someone to determine the cause and receive the best treatment.