An esophageal spasm is an involuntary and often painful contraction in the esophagus, or food pipe. Painful esophageal spasms may disrupt a person’s life, but certain treatments and remedies can help relieve the symptoms.

The esophagus is the tube that connects the mouth and stomach. Usually, it uses a series of controlled, coordinated contractions to transport food from the mouth to the stomach.

Certain foods or underlying conditions can sometimes trigger abnormal muscle spasms in the esophagus. These contractions may last only a few minutes or up to several hours.

In this article, we look at the causes of esophageal spasms and explain how to relieve the symptoms using medication, natural remedies, and dietary changes.

Esophageal spasms are fairly rare, and there are two main types:

  • Nutcracker spasms: These spasms are intensely painful but do not cause regurgitation, which is when acid or other substances come back up from the stomach into the esophagus.
  • Diffuse esophageal spasms: These spasms are less painful but can cause regurgitation.

A person with esophageal spasms may experience the following symptoms:

  • an intense pain or tight feeling in the chest, which they may mistake for heart pain
  • the feeling of something being stuck in the throat or chest
  • difficulty swallowing
  • heartburn
  • food or liquid coming back up into the throat

Doctors can diagnose esophageal spasms using a special test in which a person swallows barium to make the esophagus visible in an X-ray. They might also recommend manometry, which uses a thin, specialized tube to measure esophageal contractions.

The treatment options to stop esophageal spasms vary depending on the frequency and severity of a person’s symptoms.

A doctor may recommend several different approaches for treating esophageal spasms, including:

  • identifying and avoiding trigger foods
  • making lifestyle changes
  • trying natural remedies
  • managing underlying medical conditions
  • taking medication
  • undergoing surgery

Identifying and avoiding trigger foods

Some people with esophageal spasms can identify the foods and drinks that trigger their symptoms. Once they know what these trigger foods are, they can avoid them in the future.

Keeping a food diary can help people learn which foods trigger esophageal spasms. They should record the following information in their food diary:

  • the type of food or drink
  • whether it was hot or cold
  • the amount that they consumed
  • any adverse reactions, such as food allergies

Dietary factors that commonly trigger esophageal cramps include:

  • red wine
  • spicy food
  • food that is very hot or cold

Lifestyle changes

A doctor may recommend certain lifestyle changes for people with esophageal spasms, including:

  • reaching or maintaining a moderate weight
  • avoiding constrictive clothing
  • eating smaller meals more frequently
  • avoiding eating too close to bedtime or before lying down
  • quitting smoking
  • reducing the intake of alcohol, especially red wine

Natural remedies

Some research suggests that using peppermint products may help reduce esophageal spasms.

A 2018 review suggests that peppermint oil may be effective in treating distal esophageal spasms in some people. Peppermint oil can help relax the muscles, including those in the esophagus.

Peppermint lozenges may be a simple way to administer this natural remedy.

Licorice and menthol products may also have a relaxing effect on the muscles in the esophagus.

Managing underlying conditions

In some cases, underlying conditions such as depression, anxiety, or gastroesophageal reflux disease (GERD) can cause esophageal contractions.

A combination of medications, therapy, and stress management techniques can help a person manage underlying depression or anxiety. Antidepressants might also reduce the pain that esophageal spasms cause.

Doctors can prescribe proton pump inhibitors or H2 blockers for people with GERD, which might also help reduce throat spasms.

Medication

If traditional treatments do not work, a person may be able to try other therapies that help relax the esophageal muscles. These include botulinum toxin (Botox) injections, calcium channel blockers, and sublingual nitroglycerine, which a person places under the tongue to dissolve.

Surgery

Doctors may use surgery as a last resort if other remedies have not worked. There are two procedures available:

  • Myotomy: A surgeon cuts the muscles at the lower end of the esophagus to weaken the spasms. There is a need for more long-term research on the efficacy of this surgery.
  • Peroral endoscopic myotomy (POEM): A surgeon guides an endoscope with a tiny camera through the person’s mouth and down their throat. They then make an incision in the esophagus to weaken the spasms.

Botulinum injections

In some cases, a doctor may suggest an injection of Botox to help reduce esophageal spasms. This protein is derived from bacteria, and it temporarily paralyzes the muscles.

The International Society for Diseases of the Esophagus’s 2018 guidelines recommend that doctors primarily use Botox injections to treat older adults with esophageal achalasia who have found other remedies ineffective.

During the procedure, a doctor uses an endoscope to help inject Botox into the lower end of the esophagus, where it narrows and joins the stomach. The Botox helps relax the esophageal muscles. The procedure typically takes less than 15 minutes.

A 2020 literature review concludes that most people see a reduction in esophageal spasms after an injection of Botox but may need a second injection months or years later. It also suggests that people older than 50 years are more likely to see a reduction in symptoms.

A 2016 study reviewed the use of Botox injections to treat throat spasms at four university hospitals in Europe and North America over a 6-year period. It found that Botox therapy was the safest option for individuals whom doctors deemed to be high risk.

Any time someone experiences intense pain or a squeezing sensation in the chest, they should seek immediate medical care. Although these symptoms can indicate an esophageal spasm, it is crucial to rule out other serious medical issues, including a heart attack.

As part of the diagnostic procedure for esophageal spasms, a doctor will ask a person about their symptoms and carry out a series of tests, including:

  • an endoscopy to check inside the esophagus
  • X-rays using barium
  • esophageal pH tests to see whether stomach acid is backing up into the esophagus
  • esophageal manometry, which measures contractions while a person drinks water

It is not always clear what causes esophageal spasms, but some factors may put the nerves in the esophagus at risk of malfunctioning.

These factors include:

  • anxiety and depression
  • GERD
  • some foods and drinks
  • certain cancer treatments, including surgery on the neck or radiation therapy on the chest

Risk factors that may increase the likelihood of an esophageal spasm include:

  • a history of GERD
  • consuming very hot or very cold food or beverages
  • drinking red wine
  • having high blood pressure

Below, we provide answers to some questions that people often ask about esophageal spasms.

How do I stop esophageal spasms?

The best way to stop an esophageal spasm is to prevent it from starting. Identifying the foods and drinks that trigger muscle spasms in the esophagus and then avoiding them can be a good starting point.

Medication may help control the symptoms of esophageal spasms. The options include sublingual nitroglycerine, calcium channel blockers, and natural remedies, such as peppermint oil, which may help stop sudden throat spasms.

How long does it take for esophageal spasms to go away?

Esophageal spasms can last minutes to hours. Avoiding triggers and taking any prescribed medications can help reduce esophageal spasms. Surgery may also help, as may Botox injections, in some cases.

Esophageal spasms are painful but otherwise not harmful. Treatments are available to help people with esophageal spasms manage and prevent their symptoms.

Avoiding triggers and making lifestyle changes are often the recommended way to treat and prevent esophageal spasms.

It is also essential for someone with this condition to treat any underlying conditions that may be contributing, such as depression, anxiety, or GERD.