Esophageal Spasms

What is an esophageal spasm?

Esophageal spasms are painful, abnormal contractions of the muscles in your esophagus, which is the long pipe your food travels through to reach your stomach. These spasms cause chest pain and make it hard to swallow when you eat. Sometimes you may experience spasms when there isn’t any food in your esophagus.

There are two types of esophageal spasms: diffuse esophageal spasms and nutcracker esophagus. Diffuse esophageal spasms are uncoordinated contractions of the esophagus so food doesn’t move down the tube normally. Nutcracker esophagus is when esophageal contractions are too powerful, causing pain.

Though chest pain and difficulty swallowing feel scary, esophageal spasms are rarely dangerous. Experts don’t know what causes them, but anxiety is thought to play a role. Gastrointestinal reflux disease (GERD) may also contribute to them.

There are several types of medications that treat esophageal spasms. But in some cases, you may need a nonsurgical procedure to get your spasms under control.

Most common symptoms

The two most common symptoms are chest pain or trouble swallowing or both. The chest pain is usually in the middle of the chest and feels like cramping or pressure-like pain. It is not always related to eating. Your doctor will want to rule out heart problems if you have chest pain, and other issues like GERD.

Main symptoms

• Chest pain, cramping or pressure-like pain
• Trouble swallowing (sometimes related to drinking certain beverages, such as red wine or very hot or cold drinks)
• Feeling like an object is stuck in your throat

Other symptoms you may have

• Acid reflux
• Weight loss

Next steps

See your doctor if you’re having esophageal spasms. If your doctor suspects you have GERD spasms, they may recommend taking an antacid to see if that helps.

If GERD is not suspected, you may get a test called manometry, which measures the pressure in your esophagus when you swallow. This helps determine which type you have: diffuse esophageal spasms or nutcracker esophagus.

Your doctor may also recommend tests such as an endoscopy to rule out other conditions, such as a mass in the esophagus or eosinophilic esophagitis, in which white blood cells called eosinophils build up in your esophagus. A rare disorder called achalasia, which causes problems with passing food through the sphincter in the lower esophagus, will also be ruled out.

Though esophageal spasms are rarely dangerous, the pain they cause can feel like a heart attack. If you have a history of cardiac problems or are having severe chest pain, you should go to the emergency room immediately.

Risk factors

• Older age (spasms usually develop around age 60)
• Hypertension
• Diabetes
• Depression
• Anxiety
• A history of GERD

Causes of esophageal spasms

It’s not always clear what triggers esophageal spasms. Sometimes they’re a symptom of heartburn or a less common condition like achalasia. It’s thought that the spasms may be caused by an issue with the movement of the esophagus, over-contraction of muscles in the esophagus, or hypersensitivity to pain in the esophagus.

Esophageal spasms caused by anxiety

It’s possible that anxiety contributes to esophageal spasms. If you have anxiety, your doctor may recommend relaxation techniques or talk therapy.

Treatment of esophageal spasms

Medication

Your doctor may recommend medications that relax the esophageal muscles, such as nitrates, phosphodiesterase inhibitors, and calcium channel blockers. The pain can be treated with drugs such as tricyclic antidepressants.

Procedures

If your muscle spasms are caused by achalasia, your doctor may suggest injecting Botox in your lower esophageal sphincter, which relaxes the esophageal muscles. Another treatment option is pneumatic dilation, in which a high-pressure balloon is used to widen your esophagus. Both treatments are non-surgical procedures.