Esophageal spasm

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Esophageal spasm or oesophageal spasm is a disorder of esophageal motility. The esophagus is an organ in vertebrates which consists of a fibromuscular tube through which food passes, aided by peristalsis contractions, from the upper esophageal sphincter to the stomach through waves of coordinated muscle contraction, or peristalsis.[1]

There are two types of esophageal spasm:

  • Diffuse esophageal spasm (DES), where there is uncoordinated esophageal contractions where several sections of the esophagus can contract at once.
  • Nutcracker esophagus (NE) also known as hypertensive peristalsis, where the contractions are coordinated but with an excessive amplitude.

Both conditions can be linked with Gastroesophageal reflux disease (GERD).[1] DES and nutcracker esophagus are clinically indistinguishable and can only be differentiated by performing esophageal manometry.

When the coordinated muscle contraction are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. These spasms can prevent food from reaching the stomach where food gets stuck in the esophagus. At other times the coordinated muscle contraction is very powerful, which is called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain.[2]

Symptoms[edit]

Esophageal spasm is rare. Often, symptoms that may suggest esophageal spasm are the result of another condition such as food intolerance,gastroesophageal reflux disease (GERD) or achalasia.[2] The symptoms can commonly be mistaken as heart palpitations. The symptoms can also include dysphagia, regurgitation, noncardiac chest pain,[3] heartburn,[4] globus pharyngis (which is a feeling that something is stuck in the throat) or a dry cough.[5]

Causes[edit]

It is not clear exactly what causes esophageal spasms.[5] Sometimes esophageal spasms start when someone eats hot or cold foods or drinks. However, they can also occur with eating or drinking.[5] The increased release of acetylcholine may also be a factor, but the triggering event is not known.[4]Spasms may also be the result of a food intolerance.

Treatment[edit]

Since esophageal spasms are often associated with other disorders, management in these cases involve attempts to correct the underlying problem (eg: Food allergy/intolerance, GERD, stress, anxiety). Pharmacotherapy options include use of calcium channel blockers (CCBs) and nitrates. Tricyclic antidepressants (TCA) and sildenafil can be used as alternative treatment options. If caused by food allergy, an elimination diet may be necessary. For some, the least invasive treatment for instant relief can drinking Coca Cola to relax the spasms. If medical therapy fails, or in extreme cases, surgical approach with a myotomy can be used to relieve the symptoms.

Notes[edit]

  1. ^ a b "Oesophageal Spasm". EMIS Health. Retrieved 2015-11-15.
  2. ^ a b "Esophageal Spasm - Topic Overview". WebMD. Retrieved 2015-11-15.
  3. ^ "Esophageal Spasm". WebMD. Retrieved 2015-11-15.
  4. ^ a b "Esophageal Spasm Clinical Presentation - History". WebMD. Retrieved 2015-11-15.
  5. ^ a b c "Esophageal Spasms & Strictures". Cleveland Clinic. Retrieved 2015-11-15.