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 spasms typically occur only occasionally and might not need treatment. But sometimes the spasms are frequent and can prevent food and liquids from traveling through the esophagus. If esophageal spasms interfere with your ability to eat or drink, treatments are available.
Signs and symptoms of esophageal spasms include:
- Squeezing pain in your chest. The pain is often intense, and you might mistake it for heart pain (angina).
- Difficulty swallowing, sometimes related to swallowing specific substances, such as red wine or extremely hot or cold liquids.
- The feeling that an object is stuck in your throat.
- The return of food and liquids back up your esophagus (regurgitation).
When to see a doctor
The squeezing chest pain associated with esophageal spasms can also be caused by a heart attack. If you experience squeezing chest pain, seek immediate medical care.
It's not clear what causes esophageal spasms. However, they appear to be related to abnormal functioning of nerves that control the muscles you use when you swallow.
A healthy esophagus normally moves food into your stomach through a series of coordinated muscle contractions. Esophageal spasms make it difficult for the muscles in the walls of your lower esophagus to coordinate in order to move food to your stomach.
There are two types of esophageal spasms:
- Occasional contractions (diffuse esophageal spasms). This type of spasm may be painful and is often accompanied by regurgitation of food or liquids.
- Painfully strong contractions (nutcracker esophagus). Although painful, this type of spasm — also referred to as jackhammer esophagus — may not cause regurgitation of food or liquids.
Esophageal spasms are a rare condition. They tend to occur in people between the ages of 60 and 80, and may be associated with gastroesophageal reflux disease (GERD).
Other factors that can increase the risk of esophageal spasms include:
- High blood pressure
- Anxiety or depression
- Drinking red wine or consuming very hot or very cold foods or drinks
Your doctor might recommend:
- Endoscopy. A flexible tube (endoscope) that is passed down your throat allows your doctor to see the inside of the esophagus. Your doctor may remove a tissue sample (biopsy) for testing to rule out other esophageal diseases. X-ray. Images of your esophagus are taken after you swallow a contrast liquid.
- Esophageal manometry. This test measures muscle contractions in your esophagus when you swallow water
- Esophageal pH monitoring. This test can determine if stomach acid is flowing back into your esophagus (acid reflux).
Treatment depends on the frequency and severity of your esophageal spasms.
If your spasms are occasional, your doctor might recommend avoiding trigger foods or situations.
If your spasms make it difficult to eat or drink, your doctor might recommend:
- Managing any underlying conditions. Esophageal spasms are sometimes associated with conditions such as heartburn, GERD, anxiety or depression. Your doctor might recommend a proton pump inhibitor — such as lansoprazole — to treat GERD, or an antidepressant, such as trazodone or imipramine (Tofranil). Antidepressants might also help reduce the sensation of pain in the esophagus.
- Medications to relax your swallowing muscles. Sildenafil (Revatio, Viagra), onobotulinumtoxin A (Botox) injections or calcium channel blockers, such as diltiazem (Cardizem CD, Tiazac, others), can reduce the severity of spasms.
- Surgery (myotomy). If medication doesn't work, your doctor might recommend a procedure that involves cutting the muscle at the lower end of the esophagus, to weaken esophageal contractions. Long-term studies of this approach aren't available, so myotomy generally isn't recommended for esophageal spasms. However, it might be considered if other treatments don't work.
- Peroral endoscopic myotomy (POEM). In this new minimally invasive technique, an endoscope inserted through your mouth and down your throat allows an incision in the inside lining of your esophagus. Then, as in myotomy, the surgeon cuts the muscle at the lower end of the esophagus. Like myotomy, POEM is usually considered only if other treatments don't work.
To help you cope with occasional esophageal spasms, try to:
- Avoid your triggers. Make a list of foods and beverages that cause your esophageal spasms.
- Choose food that is warm or cool. Let foods and drinks that are very hot or very cold sit for a bit before eating or drinking them.
- Find ways to control stress. Esophageal spasms may be more common or more severe when you're stressed.
- Suck a peppermint lozenge. Peppermint oil is a smooth-muscle relaxant and might help ease esophageal spasms. Place the peppermint lozenge under your tongue.
You may be referred to a doctor who specializes in the digestive system (gastroenterologist).
What you can do
- Be aware of any pre-appointment restrictions, such as fasting before your appointment.
- Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
- Write down any triggers to your symptoms, such as specific foods.
- Make a list of all your medications, vitamins and supplements.
- Write down your key medical information, including other conditions.
- Write down key personal information, including any recent changes or stressors in your life.
- Write down questions to ask your doctor.
- Ask a relative or friend to accompany you, to help you remember what the doctor says.
Questions to ask your doctor
- What's the most likely cause of my symptoms?
- What tests do I need? Is there any special preparation for them?
- Is my condition likely temporary or chronic?
- What treatments are available?
- What types of foods are likely to make my symptoms worse?
- I have other health problems. How can I best manage these conditions together?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:
- When did you begin experiencing symptoms? How severe are they?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve or worsen your symptoms?
- Does exertion bring on your chest pain?
- Is your chest pain associated with arm or jaw pain, shortness of breath, or nausea?
- Are your symptoms related to eating? Are they triggered by any particular food or type of food?
- Do you experience symptoms of heartburn after eating, such as a burning sensation in your chest or an acid taste in your mouth?
- Do you ever wake up during the night with heartburn, chest pain or an acid taste in your mouth?
- Do you have difficulty swallowing food, or have you had to change your diet to avoid difficulty swallowing?