Diffuse Esophageal Spasm
Uncoordinated contractions of the esophagus
Quick Facts
- Type: Esophageal motility disorder
- Main symptoms: Chest pain, difficulty swallowing
- Triggers: Hot or cold foods, stress in some people
- Diagnosis: Esophageal manometry, barium swallow
Overview
Diffuse esophageal spasm is a disorder of the way the esophagus moves food. Normally, the muscles of the esophagus contract in a smooth, coordinated wave that pushes food and liquid down toward the stomach. In this condition, the contractions become uncoordinated and sometimes simultaneous, so the wave does not move food along effectively.
These abnormal contractions can cause episodes of chest pain and difficulty swallowing. The chest pain can be intense and is sometimes mistaken for heart-related pain, which understandably causes alarm. While the condition can be uncomfortable and disruptive, it is not life-threatening, and several treatments can help control symptoms.
Symptoms
Symptoms tend to come and go and may be triggered by eating or stress. They include:
- Chest pain or pressure behind the breastbone, which may be severe and can mimic heart pain
- Difficulty swallowing both solids and liquids
- A feeling that food is stuck in the chest
- Regurgitation of food or liquid
- A sense of something caught in the throat
Symptoms triggered by very hot or very cold drinks are common. Because the chest pain can resemble that of a heart attack, new or severe chest pain should always be evaluated urgently to rule out a cardiac cause first.
Causes
The exact cause of diffuse esophageal spasm is not fully understood. It is thought to result from a problem with the nerves that control the timing and coordination of esophageal muscle contractions, leading to disorganized squeezing rather than a smooth wave.
Several factors may contribute to or worsen episodes:
- Acid reflux irritating the esophagus
- Very hot or very cold foods and drinks
- Emotional stress and anxiety
The condition is one of several esophageal motility disorders and is related to, but distinct from, achalasia.
Risk Factors
- Long-standing acid reflux or heartburn
- Anxiety, depression, or high stress levels
- Middle age and older, when the condition is more often diagnosed
- Sensitivity to temperature extremes in food and drink
Diagnosis
Because chest pain can have many causes, doctors first rule out heart disease, then test esophageal function:
- Esophageal manometry: The main test, measuring the pressure and timing of muscle contractions to confirm uncoordinated spasms.
- Barium swallow: X-rays during swallowing may show a corkscrew or irregular pattern in the esophagus.
- Upper endoscopy: Used to look for reflux damage, narrowing, or other problems.
- Cardiac evaluation: Often done first to exclude a heart cause for chest pain.
Treatment
Treatment aims to relax the esophageal muscle, reduce triggers, and ease symptoms. Options include:
- Treating reflux: Acid-reducing medication such as a proton pump inhibitor if reflux contributes to spasms.
- Muscle-relaxing medicines: Drugs such as certain calcium channel blockers or nitrates may relax the esophagus and reduce pain.
- Managing stress and anxiety: Relaxation techniques, and sometimes low-dose medications that affect pain perception, can help.
- Dietary changes: Avoiding very hot or cold foods and eating slowly.
- Procedures: In severe, treatment-resistant cases, botulinum toxin injections or a muscle-cutting procedure may be considered.
Most people manage symptoms well with a combination of these measures.
Because the condition tends to come and go, treatment is often adjusted over time based on how well symptoms are controlled. Keeping a simple record of what triggers episodes, such as particular foods, drink temperatures, or stressful situations, can help you and your doctor find the most effective approach. Reassurance also plays a role, since understanding that the chest pain comes from the esophagus rather than the heart, once that has been confirmed, can reduce the anxiety that itself can worsen symptoms.
Prevention
- Eat slowly and chew food thoroughly
- Avoid very hot or very cold foods and drinks if they trigger symptoms
- Manage acid reflux and avoid known reflux triggers
- Use stress-reduction techniques such as deep breathing or counseling
- Avoid large meals close to bedtime
When to See a Doctor
Because the chest pain of esophageal spasm can closely resemble a heart attack, treat new, severe, or unfamiliar chest pain as an emergency.
- Call emergency services for chest pain with shortness of breath, sweating, or pain spreading to the arm or jaw
- See a doctor for recurring chest pain or difficulty swallowing once heart problems are ruled out
- Seek care for unintended weight loss or food consistently getting stuck
Frequently Asked Questions
Is esophageal spasm dangerous or a sign of a heart problem?
Diffuse esophageal spasm itself is not life-threatening, but its chest pain can closely mimic a heart attack. For that reason, any new, severe, or unfamiliar chest pain should be treated as an emergency until a heart cause has been ruled out.
What triggers esophageal spasms?
Common triggers include very hot or very cold foods and drinks, acid reflux, and emotional stress. Identifying and avoiding your personal triggers is an important part of managing the condition.
How is diffuse esophageal spasm diagnosed?
Doctors usually first rule out heart disease, then confirm the diagnosis with esophageal manometry, which measures the timing and strength of muscle contractions. A barium swallow may show an irregular or corkscrew pattern.
Can esophageal spasm be cured?
There is no single cure, but symptoms can often be well controlled. Treating reflux, using muscle-relaxing medications, managing stress, and avoiding triggers help most people, and procedures are available for severe, persistent cases.
Why does swallowing feel difficult with esophageal spasm?
Because the esophageal muscles contract in an uncoordinated way, food and liquid are not pushed smoothly toward the stomach. This can make swallowing feel difficult and create a sensation that food is stuck in the chest.
References
- American College of Gastroenterology. Esophageal motility disorders.
- Mayo Clinic. Esophageal spasms.
- MedlinePlus, U.S. National Library of Medicine. Esophagus disorders.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Digestive diseases.