Esophageal spasms are painful contractions within the muscular tube connecting your mouth and stomach (esophagus). Esophageal spasms can feel like sudden, severe chest pain that lasts from a few minutes to hours. Esophageal spasm can be divided into 2 major variants that are distinct entities: diffuse esophageal spasm and hypertensive peristalsis. Diffuse esophageal spasm is characterized by contractions that are of normal amplitude but are uncoordinated, simultaneous, or rapidly propagated. Hypertensive peristalsis, also known as nutcracker esophagus, is diagnosed when contractions proceed in a coordinated manner but the amplitude is excessive.
Symptoms can include dysphagia, regurgitation, and noncardiac chest pain. Because of the vague symptoms and difficulty in diagnosis, esophageal spasm is often underdiagnosed and therefore not adequately treated. In many patients, manometric and radiologic abnormalities may not correlate with symptom presentation. Because the symptoms are mild (or even absent) in many patients, true incidence is not known.
Pain 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 may help reduce stomach acid and prevent heartburn. Botulinum toxin injections are given as shots into your esophagus to relax the muscles. You may need surgery if other treatments do not improve your symptoms. Dilators to widen your esophagus are gently inserted through a scope into your esophagus. Myotomy is performed muslces in your esophagus are cut to widen the area and allow food and liquids to move into the stomach more easily.
The incidence of esophageal spasm is about 1 case in 100,000 population per year. The symptoms range from mild to severe. Patients with mild symptoms often do not seek medical attention. Because of the similarity of symptoms of reflux disease and esophageal spasm, many patients may be misdiagnosed with reflux. Furthermore, reflux and spasm can occur concomitantly. Esophageal spasm seemingly is more common in whites, and it may be more common in women than in men. However, esophageal spasm is rare in children, and incidence increases with age.