Esophageal spasm is a disorder of

motility Motility is the ability of an organism to move independently using metabolism, metabolic energy. This biological concept encompasses movement at various levels, from whole organisms to cells and subcellular components. Motility is observed in ...

of the

esophagus The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...

. There are two types of esophageal spasm: * Diffuse or distal esophageal spasm (DES), where there is uncoordinated esophageal contractions *

Nutcracker esophagus Nutcracker esophagus, jackhammer esophagus, or hypercontractile peristalsis, is a disorder of the movement of the esophagus characterized by Peristalsis, contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive ...

(NE) also known as hypertensive peristalsis, where the contractions are coordinated but with an excessive amplitude. Both conditions are linked to

gastroesophageal reflux disease Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or ...

(GERD). DES and nutcracker esophagus present similarly and can may require esophageal manometry for differentiation. When the coordinated

muscle contraction Muscle contraction is the activation of Tension (physics), tension-generating sites within muscle cells. In physiology, muscle contraction does not necessarily mean muscle shortening because muscle tension can be produced without changes in musc ...

are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. These spasms can prevent food from reaching the stomach where food gets stuck in the esophagus. At other times the coordinated muscle contraction is very powerful, which is called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain.

Signs and symptoms

The symptoms may include trouble swallowing, regurgitation,

chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...

heartburn Heartburn is a burning sensation felt behind the breastbone. It is a symptom that is commonly linked to acid reflux and is often triggered by food, particularly fatty, sugary, spicy, chocolate, citrus, onion-based and tomato-based products. Ly ...

, globus pharyngeus (which is a feeling that something is stuck in the

throat In vertebrate anatomy, the throat is the front part of the neck, internally positioned in front of the vertebrae. It contains the Human pharynx, pharynx and larynx. An important section of it is the epiglottis, separating the esophagus from the t ...

) or a dry

cough A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and Microorganism, microbes. As a protective reflex, coughing can be repetitive with the cough reflex fol ...

Causes

It is not clear what causes esophageal spasms. Sometimes esophageal spasms start when someone eats hot or cold foods or drinks. However, they can also occur without eating or drinking. The increased release of

acetylcholine Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Par ...

may also be a factor, but the triggering event is not known. Spasms may also be the result of a food intolerance.

Diagnosis

The diagnosis is generally confirmed by esophageal manometry. DES is present when more than a fifth of swallows results in distal esophageal contractions. NE is present if the average strength of the contractions of the distal esophagus is greater than 180 mmHg but the contraction of the esophagus is otherwise normal.

Differential diagnosis

Often, symptoms that may suggest esophageal spasm are the result of another condition such as food intolerance,

(GERD) or

achalasia Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esopha ...

. The symptoms can commonly be mistaken as heart palpitations.

Treatment

Since esophageal spasms are often associated with other disorders, management in these cases involve attempts to correct the underlying problem. Medications may include use of calcium channel blockers (CCBs) and nitrates. Tricyclic antidepressants (TCA) and

sildenafil Sildenafil, sold under the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary hypertension, pulmonary arterial hypertension. It is also sometimes used off-label for the treatment of certain sym ...

can be used as alternative treatment options. If caused by food allergy, an elimination diet may be necessary. There have been reports of treatment of distal esophageal spasm in 8 patients using low amounts of peppermint oil (five drops of peppermint oil in 10ml of water), and a report of treatment of an elderly patient with the same diagnosis.

Procedures

If medical therapy fails either

botulinum toxin Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium ''Clostridium botulinum'' and related species. It prevents the release of the neurotransmitter acetylcholine from axon en ...

injection or surgical

myotomy Myotomy is a surgical procedure that involves cutting a muscle to relieve constriction, often performed in the gastrointestinal or urological systems. The procedure can alleviate symptoms caused by muscle-related functional obstructions, particu ...

may be tried in distal esophageal spasms.

Epidemiology

Distal esophageal spasm is rare.

References

{{Authority control Abdomen Digestive system Diseases of oesophagus, stomach and duodenum