Esophageal Spasms

Your esophagus is the tube that carries food from your mouth to your stomach. Sometimes, the muscles in this tube have spasms—sudden, tight contractions. These spasms can cause a sharp, painful feeling in your chest, similar to the pain of a heart attack (angina).

These spasms often happen only occasionally and don't need treatment. But if they happen frequently, they can make it hard for food and drinks to move through your esophagus. This can make it difficult or painful to eat and drink. If the spasms interfere with your ability to swallow, there are ways to treat them.

The esophagus is a tube that carries food and liquids from your mouth to your stomach. It's made of muscles that work like a tiny, moving pipeline. These muscles contract and relax in a wave-like motion to push food down.

Esophageal spasms can cause some uncomfortable symptoms. These spasms are basically sudden tightening or squeezing of the muscles in the esophagus. Here's what you might experience:

• Pain in your chest: This pain can be sharp and intense, and it sometimes feels very similar to heart pain or heartburn. It's important to remember that if you're experiencing chest pain, you should seek medical attention right away to rule out any serious problems.

• Trouble swallowing: You may have difficulty swallowing both solids and liquids. Sometimes, certain foods or drinks can trigger this problem. For example, red wine, or very hot or very cold foods and drinks can be more likely to cause trouble. This is because they can irritate the esophagus.

• Feeling like something is stuck: You might feel as though there's a lump or object lodged in your throat.

• Food or liquid coming back up: This is called regurgitation. Food or liquids can come back up into the esophagus or even into your mouth.

It's important to note that these symptoms can vary from person to person, and the severity of the symptoms can also change. If you're experiencing any of these symptoms, it's crucial to consult a doctor for a proper diagnosis and treatment plan.

A squeezing pain in your chest, a symptom of esophageal spasms, can also be a sign of a heart attack. If you experience this kind of chest pain, it's crucial to get immediate medical attention. A heart attack is a serious medical emergency, and prompt treatment is essential. Don't delay; seek help right away.

Esophageal spasms are a condition where the muscles in the esophagus, the tube that carries food from your mouth to your stomach, don't work properly. We don't fully understand why this happens, but it seems to be connected to problems with the nerves that tell the muscles what to do.

Normally, swallowing involves a series of controlled muscle contractions that push food down into your stomach. In people with esophageal spasms, the muscles in the lower part of the esophagus can't coordinate these contractions smoothly. This means food can get stuck or move very slowly, making swallowing difficult or painful.

There are two main types of esophageal spasms. One is called distal esophageal spasm. In this type, the muscles in the lower part of the esophagus contract unusually and forcefully, causing the problems with moving food. The other type is called hypercontractile esophagus, or nutcracker esophagus. This involves the muscles contracting too much, like a nutcracker squeezing the food down, and also making swallowing difficult due to the excessive squeezing.

Esophageal spasms, which cause pain and difficulty swallowing, can be influenced by several factors. One important factor is sex. Women are diagnosed with esophageal spasms more often than men. Another factor is age. Most people who experience esophageal spasms are around 60 years old. This isn't always the case, but age 60 is a common age for these spasms to develop.

To figure out what's causing esophageal spasms, doctors might use a few different tests.

1. Upper Endoscopy: A doctor uses a thin, flexible tube with a tiny camera on the end to look inside your esophagus, stomach, and the beginning of your small intestine (the duodenum). This lets them see any problems directly. They can also take a small tissue sample (called a biopsy) from the esophagus to check for other diseases.

2. X-rays of the Upper Digestive System (Esophagram): For this test, you drink a special, chalky liquid. X-rays are then taken to create an image of your esophagus, stomach, and upper intestines. The liquid coats the inside of your digestive tract, making it easier for the doctor to see the different parts. Some people may have loose stools for a day or two afterward.

3. Esophageal Manometry: This test measures how your esophagus muscles contract and relax when you swallow. It looks at how well your esophagus muscles coordinate their movements, how strong the contractions are, and how well the lower esophageal sphincter (a ring of muscle at the bottom of the esophagus) opens and closes during swallowing. This helps pinpoint problems with the muscles' coordination and strength.

Treatment for esophageal spasms depends on how frequently and how severely they occur. If spasms are infrequent, a doctor might suggest avoiding extremely hot or cold foods first, as this could be enough to relieve the symptoms.

If spasms make eating or drinking difficult, treatment options might include:

• Addressing underlying conditions: Sometimes, esophageal spasms are linked to other problems like heartburn or GERD (Gastroesophageal Reflux Disease). If GERD is a factor, a doctor might prescribe a medication called a proton pump inhibitor to reduce acid reflux. In some cases, an antidepressant, such as imipramine, might be used to help lessen the pain sensation in the esophagus.

• Medications to relax the swallowing muscles: Different medications can help relax the muscles involved in swallowing. These might include peppermint oil, injections of a medicine called onabotulinumtoxinA (Botox) directly into the esophagus, or calcium channel blockers like diltiazem. These medications aim to reduce the severity of spasms.

• Surgery (myotomy): If medications don't work, a surgical procedure called a myotomy might be considered. This involves cutting the muscle at the lower end of the esophagus to weaken the contractions. While there isn't a lot of long-term data on this approach, it might be an option if other treatments fail.

• Minimally invasive surgery (POEM): A newer, less invasive approach is called Peroral Endoscopic Myotomy (POEM). In this procedure, a thin, flexible tube (endoscope) is inserted through the mouth and down the throat. The surgeon uses this to make a cut in the lining of the esophagus and then, as in traditional myotomy, cuts the muscle at the lower end of the esophagus. Like traditional myotomy, POEM is typically a last resort if other treatments aren't effective.

If you're experiencing esophageal spasms, it's essential to schedule an appointment with a healthcare professional to discuss the best course of action for your specific situation.