MayoClinic.com reprints
This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints link below.
· Order reprints of this article now.
Esophageal spasms
By Mayo Clinic staffMayo Clinic Health Manager
Get free personalized health guidance for you and your family.
Get Started
About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Definition
You're really thirsty, so you take a huge gulp of a cold, carbonated beverage. Suddenly, you experience a severe pain in your midchest that lets up after a couple of seconds. This is one form of esophageal spasm. In some people, esophageal spasms can lead to chronic swallowing problems and pain.
Esophageal spasms are an uncoordinated series of muscle contractions that prevent food from traveling properly from your esophagus to your stomach. These spasms can be very painful. Chest pain is a common symptom of esophageal spasm.
Treatment of esophageal spasms in the short term may involve using medications to quickly relax the esophageal muscles. Long-term treatment may involve managing any contributing health condition, taking additional medications and altering your eating habits.
Symptoms
Esophageal spasms affect the smooth (involuntary) muscles in the walls of your lower esophagus. These spasms may occur in two forms:
- Diffuse spasms. These simultaneous or irregular contractions of esophageal muscles slow down the progress of food toward your stomach.
- Nutcracker esophagus. Food may progress to your stomach normally, but the contractions of your esophageal muscles are painfully strong. People with this type of esophageal spasm don't experience difficulty swallowing as often as people with diffuse spasms do.
For both forms of esophageal spasms, periods of contractions often occur intermittently.
Signs and symptoms of esophageal spasms include:
- Pain in your chest, often intense, which you might mistake for heart pain (angina)
- Difficulty swallowing (dysphagia)
- The feeling that an object is stuck in your throat (globus)
- Bringing food back up (regurgitation)
- Heartburn, a burning sensation that may radiate from your upper abdomen to your neck, sometimes leaving a sour taste in your mouth
Esophageal spasms can be difficult to diagnose because of their similarity to other disorders, such as gastroesophageal reflux disease (GERD), a condition in which stomach acid or bile flows back (refluxes) into your esophagus, irritating its lining.
When to see a doctor
If you have difficulty swallowing, chest pain, frequent heartburn or difficulty keeping food down, see your doctor.
Causes
Your esophagus is a long tube-like structure that connects your throat to your stomach. A healthy esophagus moves food into your stomach through a series of coordinated muscular contractions, called peristalsis. Esophageal spasms disrupt this process.
The exact cause of esophageal spasms is unknown. Some possibilities include:
- Extremely hot or extremely cold foods, although how these foods may trigger the spasms is unclear
- Gastroesophageal disease (GERD) or heartburn, conditions affecting the esophagus and which may trigger spasms
Risk factors
Esophageal spasms are more common in women, and the incidence increases with age. If you have gastroesophageal reflux disease, you may be more prone to esophageal spasms. Your doctor may test you for reflux or try a medication targeted at acid reflux.
Preparing for your appointment
Your first appointment will usually be with your family doctor or a general practitioner. However, he or she will likely refer you to a gastroenterologist for further testing and diagnosis.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, either with your primary care doctor or the gastroenterologist, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Bring a list of any medications, as well as any vitamins or supplements, you're taking, along with the dosage of each medication.
- Write down questions to ask your doctor.
Preparing a list of questions ahead of time will help you make the most of the limited time you may have with your doctor. List your questions from most important to least important in case time runs out. For esophageal spasm, some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- Are there any other possible causes for my symptoms?
- Is there a way for me to safely tell if my chest pain is being caused by an esophageal spasm, rather than a more serious condition, such as a heart problem?
- What kinds of tests do I need? How do I need to prepare for these tests?
- Is my condition likely temporary or chronic?
- What treatments are available?
- What are the alternatives to the primary approach that you're suggesting?
- Is there anything I can do on my own, such as make changes in my diet, that will improve my symptoms?
- What types of foods are likely to make my symptoms worse?
- I have these other health conditions. How can I best manage them together?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous, or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Are your symptoms related to eating?
- Does any particular food or type of food trigger your symptoms?
- Do you experience any symptoms of heartburn after eating, such a burning in the chest or acid taste in the mouth?
- Do you ever wake up during the night with heartburn, chest pain or an acid taste in your mouth?
- Do you have difficulty swallowing food or have you had to change your diet to avoid difficulty swallowing?
What you can do in the meantime
If you know that certain types of foods tend to trigger your symptoms, avoid these foods while you're waiting to see your doctor. Foods that are either very hot or very cold may also trigger an esophageal spasm. Additionally, if you have other known health conditions, such as GERD, be sure to continue taking your medications as directed until you see your doctor.
Tests and diagnosis
Your doctor may confirm a diagnosis of esophageal spasm by these methods:
-
Barium swallow (esophagram). This is the best imaging study to help diagnose esophageal spasms and a common test for people who have difficulty swallowing. A barium swallow uses a series of X-rays to examine your esophagus. During the test, you'll drink a thick liquid (barium) that temporarily coats the lining of your esophagus so that the lining shows up clearly on X-ray images. You may also be asked to swallow a barium pill to see if it gets hung up in the esophagus.
After the test, you can eat normally and resume your daily activities, although you'll need to drink extra water to help flush the barium from your system and prevent constipation.
- Esophageal motility (manometry) test. In this test, your doctor inserts a thin tube through your nose or mouth into your esophagus to measure the effectiveness of your esophageal muscles in the swallowing process.
- Esophageal computerized tomography (CT) scan. CT scans use an X-ray-generating device that rotates around your body and a powerful computer to create cross-sectional images, like slices, of the inside of your body. This test may show abnormal thickening of your esophageal muscles, a possible indicator of esophageal spasms. This test is usually done to rule out other causes of your symptoms.
- Esophagogastroduodenoscopy (EGD). In this test, you're sedated and an endoscope is passed through your mouth and down your throat to look directly at your esophagus. This test is useful for finding any blockages in your esophagus that may cause pain or difficulty swallowing, and it may also show irritation of your esophagus from acid reflux.
Treatments and drugs
Treatment for esophageal spasms may include:
- Managing any underlying conditions. Conditions such as heartburn or GERD may trigger spasms, and treating these conditions may lessen the likelihood of esophageal spasm symptoms. Treating any underlying psychological disorders, such as anxiety or depression, also may help relieve esophageal spasms.
- Behavior modification. Your doctor or a dietitian may suggest avoiding very hot or very cold foods. Avoiding large meals and eating slowly also may be advised.
- Medications. Smooth muscle relaxants, such as calcium channel blockers or nitrates, can reduce the severity of contractions. Your doctor may also prescribe tricyclic antidepressants, such as trazodone and imipramine (Tofranil), to reduce pain. When solely treating esophageal spasms, these medications are given in lower doses than those needed to treat depression. Injection of botulinum toxin into the esophagus has also shown some benefit, but doctors approach this treatment with caution, and only after other treatments have failed. Newer treatments, such as peppermint oil and sildenafil (Viagra), have shown promise in small studies.
- Surgery. In rare cases, surgery may be an option to make esophageal contractions weaker (myotomy) or to remove your esophagus entirely (esophagectomy).
Lifestyle and home remedies
Your diet may have a dramatic effect on reducing esophageal spasms. Pay attention to which foods seem to cause the spasms.
Avoiding hot, cold or spicy foods, large meals, or foods with a high acid content (such as fruit juice, chocolate and tomatoes) may decrease the occurrence of spasms.
