Normally, contractions of the esophagus (the tube that connects the mouth and the stomach) move food from the mouth to the stomach with a regular, coordinated rhythm.
Esophageal spasm means that contractions of the
irregular, uncoordinated, and sometimes powerful. This condition may be called diffuse esophageal spasm, or DES. These spasms can prevent food from reaching the stomach. When this happens, the food gets stuck in the esophagus.
Sometimes the squeezing moves down the esophagus in a coordinated way, but it is very strong. This can be called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain.
Esophageal spasm is not common. Often, symptoms that
may suggest esophageal spasm are the result of another condition such as
gastroesophageal reflux disease (GERD) or achalasia. Achalasia is a
problem with the nervous system in which the muscles of the esophagus and the
lower esophageal sphincter (LES) don't work properly.
Anxiety or panic attacks can also cause similar symptoms.
The cause of
esophageal spasm is unknown. Many doctors believe it results from a disruption
of the nerve activity that coordinates the swallowing action of the esophagus.
In some people, very hot or very cold foods may trigger an episode.
Most people with this
condition have chest pain that may spread outward to the arms, back, neck, or
jaw. This pain can feel similar to a
heart attack. If you have chest pain, you should be
evaluated by a doctor as soon as possible to rule out or treat cardiac disease.
Other symptoms include difficulty or inability to swallow food or
liquid, pain with swallowing, the feeling that food is caught in the center of
the chest, and a burning sensation in the chest (heartburn).
Your doctor can
often find out the cause of esophageal spasm from your medical history by
asking you a series of questions. These include questions about what foods or
liquids trigger symptoms, where it feels like food gets stuck, other symptoms
or conditions you may have, and whether you are taking medicines for
The diagnosis can be confirmed with tests, including esophagus tests (such as esophageal manometry) or a
barium swallow. Esophageal manometry uses a small tube attached to instruments (transducers) that measure pressure. A barium swallow is done using X-rays.
Other tests may be done to
find out whether chest pain may be caused by gastroesophageal reflux disease
(GERD), the abnormal backflow (reflux) of food, stomach acid, and other
digestive juices from the stomach into the esophagus.
Treatment for esophageal spasm
includes treating other conditions that may make esophageal spasms worse, such
as gastroesophageal reflux disease (GERD). GERD is usually treated with changes
to diet and lifestyle and medicines to reduce the amount of acid in the
Here are some things to try:
If lifestyle changes alone aren't enough to help GERD, your doctor may suggest you try medicines that reduce stomach
acid. Over-the-counter medicines include:
Spasms may be treated directly with medicines such as
nitrates and calcium channel blockers to relax the muscles of the esophagus. But these medicines don't always work. Your doctor may also
recommend certain types of antidepressant medicines. Even though you may not be
depressed, these medicines can help with the pain.
Treating anxiety with
relaxation and controlled breathing exercises may also help to reduce
In rare cases, surgery is used
to treat esophageal spasm. The surgeon cuts the muscles along the lower
esophagus. This procedure is usually done only in serious cases that do
not respond to other therapies.
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
The American Society for Gastrointestinal Endoscopy is a group of doctors who have special training in using endoscopy to look at the digestive tract. On the website you can find a doctor in your area who does these procedures. The website also has patient education videos and patient information about endoscopic procedures.
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Other Works Consulted
Goyal RK, et al. (2009). Esophageal motility
disorders section of Oropharyngeal and esophageal motility disorders. In NJ Greenberger et al., eds.,
Current Diagnosis and Treatment: Gastroenterology, Hepatology, and Endoscopy, pp. 159–171. New York: McGraw-Hill.
May 22, 2013
E. Gregory Thompson, MD - Internal Medicine
& Peter J. Kahrilas, MD - Gastroenterology
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