- GERD and Esophageal Spasms
- What is GERD or Gastroesophageal reflux disease
- Treating GERD
- How to treat esophageal spasms
- Esophageal Spasms & Strictures
- Esophageal Spasm
- What is esophageal spasm?
- What causes esophageal spasm?
- What are the signs and symptoms of esophageal spasm?
- How is esophageal spasm diagnosed?
- How is esophageal spasm treated?
- What other treatments may my healthcare provider suggest?
- When should I contact my healthcare provider?
- When should I seek immediate care or call 911?
- Further information
- Learn more about Esophageal Spasm
- Topic Overview
- Treatment for esophageal spasm range from diet change to surgery
GERD and Esophageal Spasms
A painful and sometimes frightening problem associated with gastroesophageal reflux disease, or GERD, is esophageal spasm, which produces an intense chest-filling pain that leads some people to believe they are having a heart attack. Esophageal spasms can occur without warning, perhaps after taking a swig of a hot drink or when lying down after a big meal.
In reality, esophageal spasms are uncontrolled contractions of the muscles that normally work to move food down the esophagus from the mouth to the stomach. Gastric acid that surges into the esophagus as a result of GERD is one of the suspected causes and aggravators of esophageal spasms.
GERD: Esophageal Spasm Symptoms
There are two main types of esophageal spasm. Both of these conditions have been linked to the damage GERD causes by repeatedly bathing the nerves and muscles of the esophagus in stomach acid.
- Diffuse esophageal spasm involves the muscles contracting in an uncoordinated way, which prevents food from moving down the esophagus.
- Nutcracker esophagus occurs when the muscles of the esophagus contract too forcefully while swallowing. Nearly half the time, this condition is caused by GERD.
The symptoms are similar for both types of esophageal spasm. They include:
- Chest pain similar to that of a heart attack. This symptom is reported by 80 to 90 percent of people suffering from esophageal spasms.
- Difficulty swallowing, or feeling like food is stuck in the throat.
- Heartburn similar to that produced by GERD.
Acid reflux and GERD are known to prompt esophageal spasms. These spasms can also be triggered by drinking very hot or very cold liquids or by stress, as well as by unknown causes.
GERD: Treatment for Esophageal Spasms
People who experience GERD-related esophageal spasms can find relief by treating their GERD. The spasms tend to decrease in frequency as bouts of acid reflux decrease.
Some methods of dealing with GERD include taking medications, such as antacids, proton pump inhibitors, and H2 blockers. Lifestyle changes, such as the following, are also recommended.
- Quit smoking
- Reduce alcohol intake
- Lose weight
- Eat smaller meals
- Do not lie down for at least three hours after eating
- Wear loose-fitting clothing
- Avoid fatty foods, spicy foods, chocolate, mint, and other foods known to exacerbate reflux
There are also several ways to treat esophageal spasms directly with medication, such as:
- Taking nitrates or calcium channel blockers to relax the muscles in the esophagus. Nitroglycerin placed under the tongue also can help relax the muscles during an acute episode of esophageal spasms.
- Taking tricyclic antidepressants, which can help reduce the pain of spasms.
- Injecting botulinum toxin (Botox) into the esophageal muscles that are spasming and cannot relax. The toxin blocks the function of the nerves that are causing the spasm. It is injected through endoscopy, a procedure in which a small lighted tube with a camera is inserted into the esophagus through the throat.
The good news is that many of the preventive steps used to control GERD can help prevent esophageal spasms as well, so it’s possible to manage both problems at once.
What is GERD or Gastroesophageal reflux disease
For typical reflux symptoms, doctors often forgo diagnostic tests and proceed straight to treatment.
More serious reflux symptoms, such as bleeding from the esophagus or swallowing problems, might warrant further investigation. Individuals who don’t find relief with medications might also benefit from testing.
Diet and lifestyle changes are the foundation for treating the symptoms of reflux:
Eat smaller meals. A large meal remains in the stomach for several hours, increasing the chances for reflux. Eat several small meals throughout the day, rather than three large meals.
Relax when you eat. Stress increases the production of stomach acid. Make meals a pleasant, relaxing experience. Sit down. Eat slowly. Chew completely. Play soothing music.
Relax between meals. Relaxation therapies such as deep breathing, meditation, massage, tai chi, or yoga may help prevent and relieve heartburn.
Remain upright after eating. Remain upright for at least three hours after eating. During this time, don’t bend over, strain to lift heavy objects, or lie down.
Avoid eating within three hours of going to bed. Do not eat just before bedtime.
Lose weight, if needed. Extra pounds increase pressure on the stomach and can push acid into the esophagus.
Loosen up. Avoid tight belts, waistbands, and other clothing that puts pressure on your stomach.
Avoid foods that burn. Avoid foods that can trigger reflux. These include:
- high-fat foods
- spicy dishes
- tomatoes and tomato products
- citrus fruits
- garlic and onions
- carbonated drinks
- coffee (including decaf) and tea
Don’t smoke. Nicotine stimulates stomach acid and affects the function of the lower esophageal sphincter.
Chew gum. This increases saliva production, soothing the esophagus and washing acid back down to the stomach.
Ask your doctor about your medications. Certain drugs can cause heartburn. These include aspirin and other nonsteroidal anti-inflammatory drugs, oral contraceptives, estrogen therapy, narcotics, certain antidepressants, and some asthma medications.
Raise the head of your bed. If you’re bothered by nighttime heartburn, elevate the head of your bed by placing a wedge (available in medical supply stores) under your upper body. Don’t elevate your head with extra pillows. That makes reflux worse by bending you at the waist and compressing your stomach.
Exercise wisely. Wait at least two hours after a meal before exercising.
Several medications are used to treat GERD.
Proton pump inhibitors. These are often recommended first for frequent, uncomplicated heartburn. Proton pump inhibitors work by blocking an enzyme in the stomach that produces acid. They are available over the counter or by prescription.
Histamine H2-receptor antagonists (H2 blockers). H2 blockers are often effective for symptoms that don’t respond to antacids or lifestyle changes. They are also useful for long-term maintenance after a course of proton pump inhibitors has eased symptoms. H2 blockers act directly on the stomach’s acid-secreting cells to stop them from making acid. They are widely available either by prescription or over the counter.
Antacids. These inexpensive over-the-counter remedies neutralize digestive acids in the stomach and esophagus, at least in mild cases of heartburn. The best time to take an antacid is after a meal or when symptoms occur.
Prokinetic agents. Prokinetics help empty the stomach of acids and fluids. They can also improve muscle tone in the lower esophageal sphincter. These medications are used mainly when GERD is caused by the stomach emptying slowly.
Table: Drugs used to treat GERD
Pregnant or nursing women should not take these drugs, except on the specific advice of a physician.
alumina, aluminum carbonate, aluminum hydroxide
Amphojel, Gaviscon, Maalox, Mylanta
Relieve heartburn and functional dyspepsia pain, and promote ulcer healing by neutralizing stomach acid
Constipation; diarrhea; excessive and prolonged doses may cause bone pain, feeling of discomfort, appetite loss, mood changes, muscle weakness
Should not be used by people with moderate to severe kidney disease; should not be taken within three to four hours of taking a tetracycline-type antibiotic
Alka-Mints, Caltrate, Rolaids, Tums
Chalky taste; constipation; excessive and prolonged doses may cause difficult, painful, or frequent urination, appetite loss, mood changes, muscle pain or twitching, nausea, restlessness, unpleasant taste
Side effects more likely for people with kidney disease
magnesia, magnesium carbonate, magnesium hydroxide, magnesium trisilicate
Gaviscon, Gelusil, Maalox, Mylanta, Phillips’ Milk of Magnesia
Chalky taste; diarrhea; excessive and prolonged doses may cause difficult or painful urination, dizziness, irregular heartbeat, loss of appetite, mood changes, muscle weakness
Side effects more likely for people with kidney disease; do not use within three to four hours of taking tetracycline-type antibiotics
Alka-Seltzer, baking soda
Abdominal fullness; belching; excessive and prolonged doses may cause frequent urge to urinate, mood changes, muscle pain, nausea, restlessness
Not advisable for people on low-sodium diets; side effects more likely for people with kidney disease
*Most over-the-counter antacids contain two or more of these active ingredients.
Histamine H2-receptor antagonists
Relieve heartburn and functional dyspepsia pain, and promote ulcer healing by decreasing stomach acid
Rarely, may cause diarrhea, constipation, dizziness, anxiety, depression, drowsiness, sleeplessness, headache, irregular heartbeat, increased sweating, burning, itching, redness of skin, fever, confusion in ill or elderly people
May interfere with the absorption of anticoagulants, antidepressants, and hypertension medications
No serious drug interactions known
At high doses may interact with anticoagulants
Speeds stomach emptying
Diarrhea; less frequently, may cause involuntary movement of limbs, restlessness, drowsiness, muscle tremor, spasms, breast discharge
Increases the effects of alcohol and other depressants; caution advised for individuals with type 1 diabetes or Parkinson’s disease
Proton pump inhibitors
Treat reflux esophagitis and promote peptic ulcer healing by suppressing secretion of stomach acid
Headache, diarrhea, abdominal discomfort, gas, nausea
Prolonged use may lead to low blood levels of vitamin B12 and magnesium, and thinner bones
generic, Prilosec, Zegerid
Herbs and other natural remedies may be helpful for treating heartburn symptoms.
Chamomile. A cup of chamomile tea may have a soothing effect on the digestive tract.
Ginger. The root of the ginger plant is another well-known herbal digestive aid. It has been a folk remedy for heartburn for centuries.
Licorice. This remedy has proved effective in several studies. Licorice is said to increase the mucous coating of the esophageal lining, helping it resist the irritating effects of stomach acid. Deglycyrrhizinated licorice is available in pill or liquid form. It is considered safe to take indefinitely.
Most cases of GERD can be managed successfully with lifestyle changes and medications. But for some people, surgery is a good option.
The goal of surgery is to tighten the lower esophageal sphincter. The operations are generally effective and can eliminate the need for all GERD medications for some time. Eventually, however, many people need to resume medications and, in a small number of cases, undergo surgery to redo the procedure.
Fundoplication. The most common antireflux operation is the Nissen (360-degree) fundoplication. This procedure involves grabbing a portion of the top of the stomach and looping it around the lower end of the esophagus and lower esophageal sphincter to create an artificial sphincter. It prevents stomach acid from backing up into the esophagus.
Partial fundoplication, in which the stomach is wrapped only partway around the esophagus, is another option.
Today, most surgeons perform fundoplication as a laparoscopic procedure. That means special instruments and cameras are inserted into tiny incisions in the upper abdomen.
G&H What are the various causes of chest pain?
SR Chest pain can arise from a number of disorders. A cardiac source is the most concerning cause, as it is the most life-threatening; thus, it must be excluded as soon as possible.
Once a cardiac source of pain has been excluded, a variety of other sources should be considered, such as muscular skeletal or pulmonary causes. For example, an individual who is exercising after a period of physical inactivity may experience discomfort, heaviness, chest pain, and possibly even damage or trauma. Muscular skeletal causes are common sources of chest pain. Chest pain can also be triggered by pulmonary conditions such as an infection in the lungs.
Once cardiac, muscular, and pulmonary conditions have been excluded, the vast majority of patients are found to have an esophageal source for their chest pain. The 3 main causes of esophageal chest pain result from an underlying disturbed nerve sensation and muscle and mucosal dysfunction. The most common esophageal cause of pain is gastroesophageal reflux disease. Reflux of acid can present with chest pain, heartburn, or swallowing difficulties; chest pain is only 1 manifestation of this condition. Esophageal chest pain can also occur when the esophagus undergoes a strong spasm caused by a motility disorder of the esophagus. The third cause of esophageal chest pain, which has been a focus of my research for the last one-and-a-half decades, is an abnormal sensory function of the esophagus called esophageal hypersensitivity. In this sensory disorder, the muscle, nerve, and receptors of the esophageal wall are overly sensitive.
Finally, anxiety or an underlying psychiatric disorder can manifest as chest pain in some individuals.
G&H How are cardiac and esophageal causes of chest pain differentiated?
SR It is often difficult to distinguish between cardiac and esophageal causes of chest pain based upon symptom presentation alone because the nerves that supply the heart also supply the esophagus. Therefore, patients may think they are experiencing pain of a cardiac origin when the pain is, in fact, coming from the esophagus. Likewise, individuals who think that they are experiencing heartburn may actually be having a heart attack. Another example is an individual who is exercising and experiencing chest discomfort and pain radiating to the arm; this scenario may appear to suggest a cardiac etiology, but exercise is also known to trigger reflux, which could result in reflux pain. Thus, physicians are increasingly relying less upon symptoms and more upon objective data.
Nevertheless, symptoms may offer some hints. For example, it is not very likely that a 20-year-old nonsmoker complaining of chest pain who is otherwise ft and active has coronary artery disease. On the other hand, it is not possible to judge whether chest pain in a 50-year-old smoker with a family history of hypertension is due to a cardiac or a noncardiac source.
For cardiac evaluation, patients should undergo a stress test and angiogram performed via magnetic resonance studies or other techniques. These tests are the most effective methods for excluding vascular disease in the heart.
G&H Beyond excluding other sources, how can physicians determine whether chest pain is esophageal in origin?
SR If a patient does not have vascular disease in the heart, the physician should consider an esophageal source for the chest pain. The first course of action is to perform an endoscopy to search for reflux disease. If reflux disease is present (ie, there is ulceration in the esophageal walls), reflux is most likely the source of the chest pain and should be treated. As very effective treatments are available for reflux, the pain will disappear in 90% of cases.
If the pain does not disappear or endoscopic testing does not show any mucosal disease, the physician should further examine the patient for reflux. To determine whether the patient has reflux disease despite no visible damage to the lining of the esophagus, the patient should undergo a 24- to 48-hour acid reflux monitoring test, which can be performed via a wire (by placing a probe in the esophagus) or wirelessly (by affixing a capsule to the esophageal lining) and recording the amount of acid reflux occurring over 1–2 days. This test is, by far, the most accurate test currently available for quantifying the amount of acid reflux over a 24- to 48-hour period and thereby provides both symptom correlation and a clear, objective definition of acid reflux disease. If a patient has chest pain but does not have reflux disease according to an endoscopy or 24- to 48-hour pH monitoring, then the chest pain is not related to acid reflux. In a small proportion of patients, the chest pain may be related to nonacid reflux.
The vast majority of the remaining patients have visceral or esophageal hypersensitivity. The best test for detecting this condition is a balloon distention test. A small balloon is inserted into the esophagus and distended. At a particular level of balloon distention, the patient will feel a sensation. If the balloon is distended further, the patient will feel discomfort. If the balloon is distended even further, the patient will feel pain. This test has been performed in healthy individuals in order to record “normal” pain thresholds. If the same balloons are placed in patients complaining of noncardiac chest pain, a large proportion of these patients will report discomfort and pain at much lower thresholds, where normal individuals report merely some sensation. Lower pain thresholds suggest that these patients have an extremely sensitive esophagus whose sensitivity is manifesting as chest pain.
My colleagues and I have conducted extensive studies on this topic and have found that in a group of patients who do not have cardiac or reflux disease, up to 75% have a positive balloon distension test. This hypersensitivity is a problem in the lining of the esophagus, where the receptors are located; in the connections between the esophagus and the brain; and in the brain’s perception of esophageal sensation. Throughout the entire pathway, dysregulation leads to abnormal perception of what should be considered normal sensory information. When healthy individuals experience some tension, the esophagus may also experience some tension, but not pain; unfortunately, patients with noncardiac chest pain experience pain because of alterations in tension receptors in the esophageal wall. We believe that there is a dysfunction in the communication between the gut and the brain in these patients and that this gut-brain dysfunction is the underlying source of esophageal hypersensitivity.
G&H Are there any other tests that can be used in these patients?
SR In my opinion, the 24- to 48-hour pH monitoring test is the gold standard diagnostic approach. However, not all physicians have access to this test, and patients may be reluctant to undergo it. An alternative diagnostic test is a therapeutic drug trial, called the omeprazole test, in which the patient takes a proton pump inhibitor—it does not matter whether it is omeprazole, lansoprazole, esomeprazole, or dexlansoprazole—twice daily for 1 week. If the patient has reflux disease, in most cases—though not all—the symptoms will resolve. This test detects reflux disease; however, it may not help to identify hypersensitivity in patients.
An ultrasound test has been used in a small, select group of patients, not as a diagnostic test, but as a mechanistic test to understand the mechanism for pain. A research group from San Diego has shown that when patients experience chest pain, there is a significant shortening in the longitudinal muscle of the esophageal wall.
Another test currently being used is an impedance pH test, which looks for reflux of both acid and nonacid materials. This test provides some useful information. However, although it is beginning to be used a bit more frequently, it has not yet been well tested in chest pain patients.
Several centers across the country offer specialized services that may be helpful to patients with esophageal chest pain; if gastroenterologists have trouble diagnosing the mechanisms of these patients, I would encourage them to send patients to these centers for more thorough evaluation.
G&H How is chest pain of esophageal origin usually treated?
SR Based upon studies that my colleagues and I have conducted as well as studies by other researchers, my current recommendation, in the absence of any contraindications, is theophylline. Th is drug is best known for relaxing muscles in the lungs, though it has also been shown to relax other muscles in the body, including the gut and esophageal wall. Theophylline also appears to have another very important specific property as an adenosine receptor antagonist. The esophageal wall and the nerve that supplies the esophagus have these receptors, which are important for modulating pain throughout the body. An adenosine infusion administered into the vein of a healthy individual lowers balloon distension thresholds. In other words, by administering adenosine, a healthy individual can be temporarily converted into a patient with noncardiac chest pain; the pain threshold that they experienced before the adenosine infusion significantly decreases, so that they now experience pain where they previously could tolerate balloon distension. Because theophylline is an antagonist to adenosine, it relieves chest pain. Several double-blind studies have shown that up to approximately 60% of patients who took 200-mg doses of theophylline twice daily reported improvement in chest pain.
G&H Is theophylline associated with any significant side effects or concerns?
SR Unfortunately, theophylline is not a “clean” drug; it has several side effects, including heartburn, palpations, sleep disturbance, and indigestion-like symptoms. Occasionally, it may cause jitteriness because of its caffeine-like effects. A drug that specifically antagonizes adenosine without causing the side effects seen in theophylline is needed. However, such a drug is not yet available; until one is, theophylline will remain in our therapeutic armamentarium.
Many gastroenterologists are uneasy about using theophylline. They should start with small doses. Although clinical trials have used 200-mg doses, I recommend starting patients on 100 mg per day with meals. If patients do not respond over several weeks of therapy and experience no side effects, they can take 100 mg twice daily and then gradually work up to 200 mg twice daily.
G&H What other medical therapies are available to treat esophageal chest pain?
SR I try to use a mechanism-based approach for diagnosing and managing esophageal chest pain. If the mechanism is identified as reflux disease, patients are treated aggressively with proton pump inhibitors, which are very effective. If the mechanism is identified as hypersensitivity, I first try to treat patients with theophylline. If they cannot tolerate this drug or it is contraindicated, low-dose antidepressants can be used. Several uncontrolled studies have been performed with sertraline, trazodone, and citalopram and have shown small improvements in chest pain. If gastroenterologists are uneasy about treating patients with low-dose antidepressants, they should follow the gradual dosing schedule I suggested with theophylline. In the small proportion of patients who have chest pain caused by spasms in the esophagus, nifedipine may be useful. Botulinum toxin type A (Botox, Allergan) has also been injected into a small number of these patients and has shown improvement.
G&H Are there any endoscopic or surgical options for treating esophageal chest pain?
SR Several experimental therapies have been attempted; however, none have been shown to be effective.
How to treat esophageal spasms
Treatment options vary depending on how frequently a person has esophageal spasms and how severe their symptoms are.
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
We discuss these treatment options below.
Identifying and avoid trigger foods
Some people with esophageal spasms can identify the foods and drinks that trigger their symptoms. Once they know which foods cause spasms, they can avoid them in the future.
Keeping a food diary can be helpful to learn which foods trigger esophageal spasms. People should record the following information in their food diary:
- the type of food or drink
- whether it was hot or cold
- the amount of food eaten in a meal
- any adverse reactions, such as food allergies
Common food and drink that triggers esophageal spasms include:
- red wine
- spicy food
- food that is very hot or cold
A doctor may recommend certain lifestyle changes for people with esophageal spasms, including:
- losing weight if a person is overweight or obese
- avoiding constrictive clothing
- eating smaller meals more frequently
- not eating too close to bedtime or before laying down
- quitting smoking
- avoiding alcohol, especially red wine
Some research suggests that using peppermint products may help reduce esophageal spasms.
A review from 2018 suggests that peppermint oil may be effective for treating distal esophageal spasm in some people. Peppermint oil can help relax the muscles, including those in the esophagus.
Mixing a few drops of food-grade peppermint extract into a glass of water and drinking it before a meal may help prevent spasms. It is important to use peppermint extract rather than peppermint essential oil, as the latter can be toxic.
Licorice and menthol products may also have a relaxing effect on the muscles in the esophagus.
Managing underlying conditions
Share on PinterestTherapy, stress-management techniques, and antidepressants, can be prescribed for pain caused by esophageal spasms.
In some cases, underlying conditions such as depression, anxiety, or gastroesophageal reflux disease (GERD) can cause esophageal spasms.
A combination of medications, therapy, and stress-management techniques can help a person manage underlying depression or anxiety. A doctor may also prescribe antidepressants for pain caused by esophageal spasms.
Doctors can prescribe proton pump inhibitors or H2 blockers for people with GERD, which may also help reduce esophageal spasms.
If traditional treatments do not work, a person may be able to try other therapies that help relax the esophageal muscles. These include Botox injections and calcium channel blockers.
Surgery for esophageal spasms may be used a last resort if other remedies have not worked. There are two procedures available:
- Myotomy, in which a surgeon cuts the muscles at the lower end of the esophagus to weaken the spasms. More long-term research needs to be done on the efficacy of this surgery.
- Peroral endoscopic myotomy (POEM), where a surgeon guides an endoscope with a tiny camera down the person’s throat through their mouth and makes an incision in their esophagus to weaken the spasms.
Esophageal Spasms & Strictures
What are esophageal spasms and strictures?
An esophageal spasm is a rare disorder characterized by abnormal muscle contractions in the esophagus.
The esophagus is the narrow muscular organ that connects the mouth to the stomach and through which foods and liquids pass after being swallowed. After food is chewed and swallowed, the lump of food moves downward through the esophagus. If the esophagus is functioning normally, peristalsis, or a wave of coordinated contractions, takes place.
However, people with distal esophageal spasm may experience simultaneous contractions in long sections of the esophagus instead of a coordinated wave of contractions. The contractions may be irregular, uncoordinated, or unusually powerful, keeping food or liquids from moving normally down the esophagus.
People who have esophageal spasms may experience:
- Chest pain which occasionally may be severe enough to be mistaken for a heart attack
- Difficulty with swallowing (dysphagia) foods or liquids
- A feeling that something is stuck in the throat
There are two main types of spasms:
- Diffuse (or distal) esophageal spasms are uncoordinated muscle contractions that occur throughout the lower two-thirds of the esophagus.
- Nutcracker esophagus is a condition in which the muscle contractions are coordinated but are too strong, causing severe pain.
What is an esophageal stricture?
An esophageal stricture occurs when the esophagus becomes abnormally narrow. Benign (non-cancerous) strictures may occur due to buildup of fibrous tissue and collagen deposits due to ulcers or chronic inflammation of the esophagus.
There are two major types of strictures: simple and complex.
- Simple is symmetric with a diameter of more than 12 mm.
- Complex is asymmetric and has a diameter of less than 12 mm.
People with esophageal strictures also have difficulty swallowing solid foods, but generally do not have problems with swallowing liquids.
What causes esophageal spasms and strictures?
No one is sure exactly what causes esophageal spasms. The nerves that regulate peristalsis, the series of muscle contractions in the esophagus, might not work properly. Sometimes spasms are triggered when a person eats hot or cold foods and beverages. However, spasms can also occur in the absence of eating or drinking.
The most common type of esophageal stricture is a peptic stricture resulting from gastroesophageal reflux disease (GERD). Unless it is treated, GERD can cause scarring and narrowing of the lower esophagus. However, now that more effective medications, such as proton pump inhibitors, have been developed to treat GERD, strictures in the lower esophagus resulting from acid reflux are less common.
Strictures may also result from:
- Radiation treatment for cancer of the head, neck, or chest
- Surgery to treat esophageal cancer or Barrett’s esophagus
- Treatment of enlarged veins in the esophagus
- Swallowing harmful chemicals or objects
- An allergic condition called eosinophilic esophagitis
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- Care Notes
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- Aftercare Instructions
- En Español
What is esophageal spasm?
Esophageal spasm is a sudden, painful tightening of your lower esophagus. Your esophagus is the tube that food and liquids pass through from your mouth to your stomach.
What causes esophageal spasm?
The cause of esophageal spasm is not clear. It may be caused by problems with the nerves that control how your esophagus moves when you swallow . Esophageal spasm may be common among family members. Foods that are too hot or too cold may increase how often your esophagus spasms. Spasms may also happen on their own.
What are the signs and symptoms of esophageal spasm?
You may have any of the following:
- Trouble when you swallow: Food may get stuck in your esophagus.
- Chest pain: You may have chest pain or discomfort that starts behind your sternum (breastbone). The pain may spread to your arms, jaw, or back. It may be mild or severe. It may also worsen when you eat.
- Heartburn: This is a burning feeling in your chest or throat caused by stomach acid that rises into your throat. This may leave a bitter taste in your mouth, and it may be worse after meals or when you lie down.
How is esophageal spasm diagnosed?
You may receive the following tests:
- Manometry: Your healthcare provider will gently insert a tube into your throat and down into your stomach. The tube has sensors on it that measure the pressure in your esophagus. This pressure shows the strength of the spasms when you swallow. The test also shows how well food and fluids move down your esophagus when you swallow.
- Endoscopy: Your healthcare provider will gently place a scope (long tube with a small camera on the end) into your throat to check for problems with the shape of your esophagus. Your healthcare provider may also check the thickness of your esophagus. Samples of your esophagus tissue may be taken and sent to a lab for tests.
- X-ray with barium swallow: An x-ray of your abdomen is a picture of your stomach and esophagus. You will drink a thick liquid called barium to help your esophagus and stomach show up better on the x-ray. Follow the instructions from your healthcare provider before and after the x-ray test.
How is esophageal spasm treated?
With treatment, your spasms, pain, and trouble swallowing may improve. Ask your healthcare provider for more information about these and other treatments for esophageal spasms:
- Pain medicine: This medicine helps take away or decrease pain caused by the spasms.
- Smooth muscle relaxants: This medicine may help your muscles and esophagus relax so it is easier for you to swallow. It may also decrease your pain and trouble swallowing.
- Proton pump inhibitors: This medicine may help reduce stomach acid and prevent heartburn.
- Botulinum toxin injections: This medicine is given as shots into your esophagus to relax the muscles. Your healthcare provider may use a scope as a guide for the injections.
- Surgery: You may need surgery if other treatments do not improve your symptoms.
- Dilatation: Dilators to widen your esophagus are gently inserted through a scope into your esophagus.
- Myotomy: Muscles in your esophagus are cut to widen the area and allow food and liquids to move into the stomach more easily.
What other treatments may my healthcare provider suggest?
Ask for more information about the following:
- Biofeedback: Biofeedback is a type of therapy that helps you control how your body reacts to stress or pain. Your healthcare provider will use electrodes (wires) on different parts of your body, such as your chest, to monitor your body responses. This may help you learn ways to reduce your pain or spasms.
- Relaxation therapy: Stress may cause pain, lead to illness, and slow healing. Relaxation therapy teaches you how to feel less physical and emotional stress. Deep breathing, muscle relaxation, and music are some forms of relaxation therapy.
When should I contact my healthcare provider?
- Your symptoms do not improve even with treatment.
- You have severe pain when you swallow.
- You lose weight without trying.
- You have questions about your condition or care.
When should I seek immediate care or call 911?
- You are drooling or have trouble swallowing .
- You are choking, gagging, or vomiting.
- You have pain when you swallow.
- You have new or worse chest pain and shortness of breath.
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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Learn more about Esophageal Spasm
- Esophageal Obstruction
- Esophageal Spasm
Normally, contractions of the esophagus (the tube that connects the mouth and the stomach) move food from the mouth to the stomach 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 that may suggest esophageal spasm are the result of another 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 properly. Anxiety or panic attacks can also cause similar symptoms.
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.
What are the symptoms?
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).
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.
How is it treated?
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.
- Dilation. In this treatment, a device is placed down your esophagus to carefully expand any narrow areas of your esophagus. You may need to have the treatment more than once.
- Surgery. Surgery is sometimes used in people who have a problem that affects the lower esophageal muscle (achalasia).
- 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.
Treatment for esophageal spasm range from diet change to surgery
Posted on Aug 11, 2016 by Keith Murray in Sea Sick ADVERTISEMENT
Recently, I ended up in the emergency room. I felt as if I was choking, but I could still breathe. I couldn’t swallow anything. It was a blockage in my esophagus, called an esophageal spasm.
Normally, when people choke, they cannot cough, talk or breathe. If this is happening, most often we perform the abdominal thrust, formerly known as the Heimlich Maneuver.
But if the person can talk, cough and breathe, we do not do the abdominal thrust. In my case, I could talk, cough and breathe, but not swallow.
First, what is the esophagus and what does it do? The esophagus is an 8-inch-long muscular tube connecting the throat with the stomach. The upper part of the esophagus that we control consciously is used when breathing, eating, belching and vomiting. This keeps food and secretions from going down the windpipe.
The lower esophagus connects to the stomach. This part prevents acid and stomach contents from traveling backward from the stomach.
An esophageal spasm happens when contractions of the esophagus are irregular, uncoordinated and sometimes powerful. This condition is also called DES or diffuse esophageal spasm. These spasms can prevent food from reaching the stomach. When this happens, the food gets stuck in the esophagus.
The causes of esophageal spasms are unknown. Many doctors believe they result from a disruption of the nerve activity that coordinates the swallowing action of the esophagus. In some people, extremely hot or cold foods may trigger an episode. In my case, I am guessing it was caused by stress. The few times this has happened before was when I was in stressful situations and eating too fast.
The symptoms include chest pain that may spread outward to the arms, back, neck or jaw. This pain can feel similar to a heart attack. Always assume a heart attack if these symptoms appear as this could be a life-threatening emergency. Anyone with chest pain should seek immediate medical attention.
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 heartburn. For me, I could feel the spasm in my chest, and I was unable to swallow anything, including saliva. I spent five hours vomiting thick saliva before I went to the emergency room for treatment.
Treatment for esophageal spasms varies. My doctor gave me an IV in the emergency room that relaxed my esophagus and made me vomit. This time, the vomiting provided instant relief. I was told to then take omeprazole, an over-the-counter acid reducer, for the next 14 days.
So far, so good. I have not had a recurrence.
Often, people with symptoms similar to mine have gastroesophageal reflux disease (GERD), which is often treated with changes to diet and lifestyle and with medicines to reduce the amount of acid in the stomach.
Treatment for esophageal spasm may include:
- Change in diet. Certain foods and liquids can make swallowing easier.
- Dilation. I had this done several years ago. The doctor put a device down my esophagus to carefully expand any narrow areas of the esophagus. I was told that a repeat procedure may be necessary every two to three years.
- Surgery. Used for those who have a problem that affects the lower esophageal muscle (achalasia).
- Medicines. Some, such as botulinum toxin, can relax the muscles in the esophagus.
Knowing what to do and when to do it is important during medical emergencies. I hope my personal experience can help someone who experiences the same symptoms.
Trained as an emergency medical technician, Keith Murray now owns The CPR School, which provides onboard CPR, AED and first-aid training as well as AED sales and service. Contact him through www.TheCPRSchool.com.
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This condition is a type of esophageal spasm characterized by powerful contractions that occur when swallowing. It is usually caused by gastroesophageal reflux, the backflow of stomach acid up the esophagus, which causes heartburn. Acid reflux that occurs more than twice a week is called gastroesophageal reflux disease (GERD), a more serious condition that, left untreated, can lead to problems such as chronic inflammation of the esophagus (esophagitis) and a precancerous condition called Barrett’s esophagus.
The symptoms of nutcracker esophagus can be alarming – chest pain so severe that it can be mistaken for a heart attack and the feeling that food is stuck under the breastbone.
Since GERD is likely to be the cause, I recommend that you take steps to deal with that. This requires addressing lifestyle factors such as smoking and excess weight as well as eating small, frequent meals instead of three large ones, avoiding lying down within three hours of eating, not eating foods that seem to trigger your symptoms and avoiding tight clothing, especially around your midsection. In addition to these measures, conventional medicine typically treats GERD with medication. Many patients are instructed to start taking over-the-counter antacids, which I advise avoiding since they only mask the symptoms. If antacids don’t help, drugs to block stomach acid production may be prescribed. It is not a good idea to use these drugs long term, both because they have significant side effects and because they can worsen the condition over time.
My recommendations for dealing with GERD include the following measures:
- Keep a logto track the foods and beverages that trigger or worsen your symptoms. Certain foods and beverages weaken or relax the esophageal sphincter including peppermint, citrus, caffeine and alcohol. Other foods have also been implicated – tomatoes, garlic, dairy products and high-fat meals. Wheat and other grains containing gluten (oats, barley and rye) are problems for some people.
- Increase your fiber consumption to at least 40 grams a day, including whole grains, fruits and vegetables.
- Avoid alcohol, or keep your consumption to a minimum, drinking it only with meals.
- Get regular exercise.
- Drink plenty of water.
- Avoid caffeinated beverages (including decaffeinated coffee), which can irritate the gastrointestinal tract
- Use DGL (deglycyrrhizinated licorice), which comes in chewable tablets and in powder form. Slowly chew two tablets or take a half-teaspoon of the powder before or between meals and at bedtime. Taper your dose down after your symptoms are under control.
You can find additional suggestions for managing symptoms of GERD here, including a trial of hypnotherapy.
I also advise practicing a relaxation strategy, since stress and anxiety can worsen GERD. Try my 4-7-8 breath, a natural tranquilizer that is subtle to begin with but gains in power with repetition and practice. Do it at least twice a day. You cannot do it too frequently. However, do not do more than four breath-cycles at one time for the first month of practice.
Andrew Weil, M.D.