Esophageal spasms are painful, abnormal muscle contractions that occur within the esophagus. The esophagus is a narrow, muscular tube that transports food and drink to the stomach. It’s about 10 inches long in adults. It has muscular walls and is lined with mucus membranes.
The esophagus is part of the digestive system. It moves food and drink downward into the stomach by making coordinated contractions. When these contractions become uncoordinated, they hinder this process instead of aiding it.
Esophageal spasms are typically rare, but they may occur with frequency in some people. This can inhibit your ability to eat and drink. When esophageal spasms happen often, they may require treatment.
It’s unclear exactly what causes esophageal spasms. They may be connected to a malfunction of the nerves that control the muscles within the esophagus. Some conditions and factors that could produce esophageal spasms include:
- certain foods and drinks, including red wine and foods that are too hot or too cold
- gastroesophageal reflex disease (GERD), particularly if its led to scarring or narrowing of the esophagus
- some treatments for cancer, such as surgery of the esophagus or radiation of the chest, neck, or head
- anxiety and depression
Esophageal spasm symptoms include:
- chest pain that’s so intense it’s mistaken for a heart attack
- a feeling that something is caught in your throat or chest
- trouble swallowing
- regurgitation of food or liquid back up into your mouth
Seek immediate medical care if you think you may be having an esophageal spasm. Given the severity of esophageal spasms and the similarity of their symptoms to angina, it’s important to be checked out by a doctor.
Your doctor may first rule out angina by giving you an EKG, stress test, or another cardiac test. Diagnostic tests for esophageal spasms include:
- Esophageal manometry: This measures muscle contractions while you swallow water.
- Barium swallow: This X-ray imaging test requires you to drink a contrast liquid to offer a better view of your esophagus.
- Endoscopy: During endoscopy, a thin, flexible tube, called an endoscope, is inserted down your throat. This allows your doctor to view the inside of your esophagus.
- Esophageal pH monitoring: This test checks for acid reflux and regurgitation by measuring the pH balance in your esophagus.
The type of esophageal spasm you’re experiencing may influence your treatment options. The two types of esophageal spasm are:
- Diffuse esophageal spasms: These spasms happen only occasionally and are usually associated with the regurgitation of food or drink.
- Nutcracker, or jackhammer, esophageal spasms: These spasms may be more painful than diffuse ones but don’t typically cause regurgitation, despite their severity.
Treatment options include:
If you have diffuse esophageal spasms, you may be able to treat them simply by identifying and eliminating food and drink triggers. No matter which type of spasms you have, keep a food diary to help you identify things that trigger spasms. Don’t just write what you eat or drink. Jot down the temperature as well as the quantity. And don’t forget to include hidden ingredients, like spices. Spicy food may be a trigger for some people.
Standardized deglycyrrhizinated licorice (DGL) extract, taken an hour or two before or after meals, may help reduce spasms. It’s available in many forms, including chewable tablets and powder.
Peppermint oil is a smooth-muscle relaxant that may also help calm down spasms. Try sucking on a peppermint lozenge or drinking a solution of water with peppermint oil drops added to it.
These are a few simple changes you can also try:
- Eat several small meals each day, instead of large servings.
- Lose weight, if your body mass index is higher than it should be.
- Increase your fiber intake.
- Reduce, or eliminate, alcohol consumption.
- Don’t eat too close to bedtime, and don’t hit the couch immediately after eating.
- Don’t smoke.
- Avoid wearing constrictive clothing.
Your doctor may prescribe medications, such as a proton pump inhibitor or an H2 blocker if you have GERD, to address the underlying cause of your symptoms. However, recent research suggests long-term use of proton pump inhibitors may result in kidney disease.
If you have anxiety or depression, antidepressants may help to lift your mood and reduce esophageal pain.
Medications may also be prescribed to relax your swallowing muscles. These include Botox injections and calcium blockers.
If medications and lifestyle changes aren’t enough to do the trick, a minimally invasive procedure called peroral endoscopic myotomy (POEM) may be tried. During this procedure, a surgeon inserts an endoscope through your mouth and then cuts the muscle at the bottom of your esophagus to weaken contractions.
Another minimally invasive surgical procedure, called the Heller myotomy, may also be an option for people with esophageal spasms.
If you’ve already had an esophageal spasm, you probably want to avoid having another one. Identifying food triggers and eliminating the substances that seem to bring on spasms is important. If your doctor has prescribed medication, be sure to follow their instructions carefully. In general, make sure to maintain healthy habits. Eat nutritious foods that are high in fiber, and lose weight if you’re overweight.
Esophageal spasms may occur as a result of an underlying condition, such as GERD or depression. Treating the underlying cause is your first line of defense in eliminating or reducing symptoms. It’s also important to maintain healthy lifestyle habits and to identify food and drink triggers that may bring on spasms. Even though their cause is not completely understood, esophageal spasms can usually be treated effectively.