Esophageal Spasm

Overview

The esophagus is the muscular tube that carries food and liquid from the throat to the stomach. Normally its muscles contract in a smooth, coordinated wave that pushes food downward. In esophageal spasm, these contractions become abnormal, either uncoordinated or too forceful, which can interfere with swallowing and cause chest pain.

There are different patterns of esophageal spasm. In one type, contractions are disorganized and poorly timed, while in another the muscles squeeze with unusually high pressure. Esophageal spasm is uncommon, and although it can be uncomfortable and alarming, it is not life threatening. Because the chest pain can resemble a heart problem, it is important to have new chest pain evaluated.

Symptoms

Symptoms come and go and may not happen with every meal. They include:

• Chest pain: A squeezing or tight pain behind the breastbone that can be intense and may spread to the back, arms, or jaw, sometimes mimicking a heart attack.
• Difficulty swallowing: A feeling that food or liquid is stuck, known as dysphagia.
• Regurgitation: Food or liquid coming back up.
• A sensation of something stuck in the chest or throat.

Symptoms are sometimes triggered by very hot or cold foods and drinks, or by stress. Any new, severe, or unexplained chest pain should be treated as a possible emergency until a heart cause is ruled out.

Causes

The exact cause of esophageal spasm is not fully understood. It appears to involve a problem with the nerves that control the timing and strength of the esophageal muscle contractions. Several factors may trigger or contribute to spasms:

• Acid reflux: Stomach acid backing up can irritate the esophagus, as in GERD.
• Very hot or very cold foods and drinks.
• Emotional stress or anxiety.
• Certain foods, such as red wine for some people.

Esophageal spasm is different from achalasia, another motility disorder in which the lower esophageal muscle fails to relax.

Risk Factors

• Gastroesophageal reflux disease (GERD)
• Frequent exposure to very hot or cold foods and beverages
• High levels of stress or anxiety
• Female sex and middle to older age, in which it is somewhat more common
• A history of other esophageal problems

Diagnosis

Because chest pain has many possible causes, diagnosis often starts by ruling out heart disease. Tests for esophageal spasm may include:

• Esophageal manometry: The main test, which measures the pressure and timing of muscle contractions as you swallow.
• Barium swallow: X-rays taken after drinking a contrast liquid, which can show abnormal contractions or a corkscrew pattern.
• Upper endoscopy: A thin camera to inspect the esophagus and rule out narrowing, inflammation, or other problems.
• Reflux testing: To check whether acid reflux is contributing.

Treatment

Treatment depends on how often symptoms occur and how much they interfere with daily life. Options include:

• Treating reflux: Acid-reducing medicines such as proton pump inhibitors, since reflux can trigger spasms.
• Muscle-relaxing medicines: Certain drugs, such as calcium channel blockers, peppermint oil, or others, may relax the esophageal muscles.
• Managing triggers and stress: Avoiding very hot or cold foods and addressing anxiety can reduce episodes.
• Procedures: For severe, persistent cases, injections or other procedures may be considered.

Many people manage well by avoiding triggers and treating reflux, and symptoms can ease over time. Because anxiety can both trigger and result from the alarming chest pain, addressing stress is often an important part of treatment. Keeping a simple diary of when episodes occur and what preceded them can help you and your clinician identify patterns and tailor the approach.

Prevention

• Avoid very hot or very cold foods and drinks if they trigger symptoms
• Eat slowly and chew food thoroughly
• Manage acid reflux with diet changes and medication if advised
• Reduce stress through relaxation techniques, exercise, or counseling
• Identify and avoid your personal food or drink triggers

When to See a Doctor

See a doctor if you have ongoing trouble swallowing, food regularly feels stuck, or you have recurring chest pain. Because esophageal spasm can mimic a heart attack, call emergency services right away if you have:

• New, severe, or crushing chest pain
• Chest pain spreading to the arm, jaw, neck, or back
• Chest pain with shortness of breath, sweating, nausea, or lightheadedness
• Inability to swallow or food completely stuck

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Esophageal spasms — Symptoms and causes.
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
3. MedlinePlus, U.S. National Library of Medicine. Esophageal spasm.
4. American College of Gastroenterology. Esophageal motility disorders.