Esophageal spasm
| Esophageal spasm | |
|---|---|
| Other names | Oesophageal spasm |
| Specialty | Gastroenterology |
| Differential diagnosis | Achalasia, angina, scleroderma, esophageal cancer, esophagitis, eosinophilic esophagitis[1] |
Esophageal spasm is a disorder of motility of the esophagus.[2]
There are two types of esophageal spasm:[2]
- Diffuse or distal esophageal spasm (DES), where there is uncoordinated esophageal contractions
- Nutcracker esophagus (NE) also known as hypertensive peristalsis, where the contractions are coordinated but with an excessive amplitude.
Both conditions are linked to gastroesophageal reflux disease (GERD).[2] DES and nutcracker esophagus present similarly and can may require esophageal manometry for differentiation.[3]
When the coordinated muscle contraction 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.[4]
Signs and symptoms
The symptoms may include trouble swallowing, regurgitation, chest pain,[5] heartburn,[6] globus pharyngeus (which is a feeling that something is stuck in the throat) or a dry cough.[7]
Complications
Apart from malnutrition, complications are generally associated with the underlying causes. Sharing a common cause, coronary vasospasm is of particular concern, since myocardial infarction and sudden cardiac death are potential outcomes.[8]
Causes
It is not entirely clear what causes esophageal spasms.[1][7] Sometimes esophageal spasms start when someone eats hot or cold foods or drinks. However, they can also occur without eating or drinking.[7] The increased release of acetylcholine may also be a factor, but the triggering event is not known.[6] Spasms may also be the result of a food intolerance.
Deficiency in nitric oxide causes spontaneous contractions.[9] The cause of esophageal spasm from deficiency can be malnutrition,[10] since nitric oxide is produced from arginine. Another cause can be increased production of nitric oxide, following depletion, as seen with long term opioid use, where dysfunctions resolve after discontinuation.[9]
Diagnosis
The diagnosis is generally confirmed by esophageal manometry.[2] DES is present when more than a fifth of swallows results in distal esophageal contractions.[2] 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.[2]
Differential diagnosis
Often, symptoms that may suggest esophageal spasm are the result of another condition such as food intolerance, gastroesophageal reflux disease (GERD), achalasia or eosinophilic esophagitis.[4][11] 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 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),[12] and a report of treatment of an elderly patient with the same diagnosis.[13]
Nitroglycerin has also been found effective at treating acute esophageal spasms, by increasing nitric oxide (NO) levels it acts as a smooth muscle relaxant which relaxes muscle cells and lowers pressure in the lower esophageal sphincter, reducing the intense, uncoordinated contractions in the esophagus and easing chest pain.[14] It is often used to treat esophageal spasms associated with eosinophilic esophagitis and Gastroesophageal reflux disease (GERD), although it appears to be less effective at treating spasms in those with GERD.[15][16]
Procedures
If medical therapy fails either botulinum toxin injection or surgical myotomy may be tried in distal esophageal spasms.[17]
Epidemiology
Distal esophageal spasm is rare.[17]
References
- ^ a b Goel, S; Nookala, V (January 2025). "Diffuse Esophageal Spasm". StatPearls. StatPearls Publishing. PMID 31082150.
- ^ a b c d e f "Oesophageal Spasm". EMIS Health. Retrieved 2015-11-15.
- ^ Lightdale, Charles J. (2009). The Foregut: Function-dysfunction. John Libbey Eurotext. p. 50. ISBN 978-2-7420-0721-9.
- ^ a b "Esophageal Spasm – Topic Overview". WebMD. Retrieved 2015-11-15.
- ^ "Esophageal Spasm". WebMD. Retrieved 2015-11-15.
- ^ a b "Esophageal Spasm Clinical Presentation – History". WebMD. Retrieved 2015-11-15.
- ^ a b c "Esophageal Spasms & Strictures". Cleveland Clinic. Retrieved 2015-11-15.
- ^ Hung, Ming-Jui; Hu, Patrick; Hung, Ming-Yow (2014). "Coronary Artery Spasm: Review and Update". International Journal of Medical Sciences. 11 (11): 1161–1171. doi:10.7150/ijms.9623. ISSN 1449-1907. PMC 4166862. PMID 25249785.
- ^ a b Zaher, Eli A.; Patel, Parth; Atia, George; Sigdel, Surendra (July 2023). "Distal Esophageal Spasm: An Updated Review". Cureus. 15 (7): e41504. doi:10.7759/cureus.41504. PMC 10404380. PMID 37551217.
{{cite journal}}: CS1 maint: article number as page number (link) - ^ Motil, Kathleen J.; Schultz, Rebecca J.; Browning, Kerrie; Trautwein, Lynn; Glaze, Daniel G. (July 1999). "Oropharyngeal Dysfunction and Gastroesophageal Dysmotility Are Present in Girls and Women with Rett Syndrome". Journal of Pediatric Gastroenterology & Nutrition. 29 (1): 31–37. doi:10.1097/00005176-199907000-00010. PMID 10400100.
- ^ Nurko, Samuel; Rosen, Rachel (January 2008). "Esophageal Dysmotility in Patients Who Have Eosinophilic Esophagitis". Gastrointestinal Endoscopy Clinics of North America. 18 (1). Elsevier Inc.: 73–89. doi:10.1016/j.giec.2007.09.006. ISSN 1558-1950. PMC 3001401. PMID 18061103.
- ^ Pimentel, M.; Bonorris, G. G.; Chow, E. J.; Lin, H. C. (July 2001). "Peppermint oil improves the manometric findings in diffuse esophageal spasm". Journal of Clinical Gastroenterology. 33 (1): 27–31. doi:10.1097/00004836-200107000-00007. ISSN 0192-0790. PMID 11418786. S2CID 46427292.
- ^ Parvataneni, Swetha; Vemuri-Reddy, Sireesha (2020-03-06). "Role of Peppermint Oil in Diffuse Esophageal Spasm in the Geriatric Population". Cureus. 12 (3) e7192. doi:10.7759/cureus.7192. ISSN 2168-8184. PMC 7137643. PMID 32269872.
- ^ Orlando, Roy C.; Bozymski, Eugene M. (5 July 1973). "Clinical and Manometric Effects of Nitroglycerin in Diffuse Esophageal Spasm". New England Journal of Medicine. 289 (1). Massachusetts Medical Society: 23–25. doi:10.1056/NEJM197307052890106. ISSN 1533-4406. PMID 4196712.
- ^ Swamy, N (January 1977). "Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites". Gastroenterology. 72 (1). Elsevier Inc.: 23–7. doi:10.1016/S0016-5085(77)80297-7. PMID 401445.
- ^ Kikendall, Walter J.; Mellow, Mark H. (October 1980). "Effect of sublingual nitroglycerin and long-acting nitrate preparations on esophageal motility". Gastroenterology. 79 (4). Walter Reed Army Medical Center, Washington D.C.: Elsevier Inc.: 703–706. doi:10.1016/0016-5085(80)90248-6. ISSN 0016-5085. PMID 6773846. Retrieved 30 December 2025.
- ^ a b Roman, S; Kahrilas, PJ (July 2015). "Distal esophageal spasm". Current Opinion in Gastroenterology. 31 (4): 328–33. doi:10.1097/MOG.0000000000000187. PMID 26039725. S2CID 25972582.