Dominic Stone
Esophageal spasms are abnormal contractions of the muscles in the esophagus, the tube that carries food and drink from the mouth to the stomach. These spasms can cause minor to severe symptoms, including difficulty swallowing, chest pain, and heartburn. While the exact cause of esophageal spasms is unknown, they may be related to muscle or nerve problems in the esophagus, as well as certain triggers such as very hot or cold food and drinks. Cricopharyngeal spasms, which occur when the cricopharyngeal muscle in the throat tightens excessively, can also cause similar symptoms and are sometimes associated with esophageal spasms. Although there are various treatments for esophageal spasms, including medication, botox injections, and surgery, the specific connection between a narrow esophagus and muscle spasms in the tongue requires further exploration and consultation with medical professionals.
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What You'll Learn
What are oesophageal spasms?
Oesophageal spasms are involuntary painful muscular contractions of the oesophagus, the tube that connects the mouth to the stomach. These spasms are caused by uncoordinated and sometimes powerful contractions of the oesophagus muscles, which can make it difficult for food or liquid to pass through to the stomach. This can result in regurgitation, or food getting stuck in the oesophagus.
Oesophageal spasms can cause severe chest pain, which may be felt at the centre of the chest, in the back, or behind the breastbone. The pain can be so severe that it is sometimes confused with the pain of a heart attack or angina. Other symptoms include difficulty swallowing, a sensation of something being stuck in the chest (known as Globus), and backflow of food into the mouth (regurgitation). Regurgitation is more common in diffuse oesophageal spasms, while difficulty swallowing is more common in nutcracker oesophagus.
There are several treatments available for oesophageal spasms, including medications such as calcium channel blockers, tricyclic antidepressants, and botulinum toxin (Botox) injections. Lifestyle changes, such as avoiding trigger foods and losing weight, can also help manage the condition. In severe cases that do not respond to other treatments, surgery may be recommended.
While the exact cause of oesophageal spasms is not well understood, several factors have been identified that may contribute to the condition. These include gastroesophageal reflux disease (GERD), diet (including red wine, hot or cold food and drinks, high-fat foods, and spicy foods), high cholesterol, and anxiety or panic attacks.
Oesophageal spasms can often be difficult to treat, and it is important to seek medical advice if you are experiencing symptoms. Doctors can diagnose oesophageal spasms through a series of tests, including electrocardiography (ECG), exercise stress testing, and oesophageal manometry to measure the pressure of contractions.
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Symptoms of oesophageal spasms
Oesophageal spasms are rare problems with the muscles in the oesophagus, the muscular tube that connects the mouth to the stomach. The oesophagus usually contracts in a coordinated way to move food or liquid to the stomach. However, oesophageal spasms cause the oesophagus to contract in an uncoordinated way, making it difficult for swallowed food or liquid to move down into the stomach.
There are two types of oesophageal spasms: distal (or diffuse) oesophageal spasms and hypercontractile (nutcracker or jackhammer) oesophagus. Distal oesophageal spasms involve uncoordinated muscle contractions that happen mostly in the lower part of the oesophagus. This type of spasm often causes already-swallowed food or liquid to come back up the oesophagus (regurgitation). Hypercontractile oesophageal spasms, on the other hand, involve muscle contractions that are too strong or forceful.
Oesophageal spasms can cause a range of symptoms, including minor to severe symptoms. The most common symptoms are difficulty swallowing and chest pain. Other symptoms include heartburn, regurgitation of food, and a burning sensation in the centre of the chest. In some cases, patients may also experience muscle spasms in the tongue, although this is not specifically mentioned in the sources.
The chest pain associated with oesophageal spasms often starts or worsens when eating or drinking very hot foods or liquids. The pain may feel similar to a heart attack. More than half of patients with distal oesophageal spasms experience the feeling of food getting stuck inside the centre of the chest.
Oesophageal spasms can be treated in several ways, including medication, botulinum toxin (Botox) injections, and surgery. Medications such as calcium channel blockers can help people swallow more easily, while nitrates can relieve chest pain. Botulinum toxin injections temporarily paralyse the oesophagus muscles, stopping spasms. Surgery, such as a myotomy, may be recommended if other treatments have not been successful.
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Causes of oesophageal spasms
Oesophageal spasms occur when the muscles in the oesophagus—the tube that connects the mouth to the stomach—contract abnormally, making it difficult for food and liquids to reach the stomach. While the exact cause of oesophageal spasms is unknown, several factors are believed to contribute to this condition.
One possible cause is faulty nerves that control how the oesophageal muscles work. These faulty nerves may be related to excess acid in the oesophagus. Consuming very hot or cold foods and beverages, or foods that are not chewed sufficiently before swallowing, can trigger spasms. Stress is also believed to be a factor, with oesophageal spasms appearing to be more common and severe in individuals experiencing stress.
Oesophageal spasms can be classified into two main types: distal (or diffuse) oesophageal spasms and hypercontractile (nutcracker or jackhammer) oesophagus. In distal oesophageal spasms, uncoordinated muscle contractions occur primarily in the lower portion of the oesophagus, often resulting in regurgitation of food or liquid. Hypercontractile oesophagus, on the other hand, is characterised by excessively strong and forceful muscle contractions, which can cause severe pain, particularly during swallowing.
Identifying and avoiding triggers is crucial in managing oesophageal spasms. Certain medications, such as calcium channel blockers and nitrates, can help alleviate symptoms and improve swallowing. Tricyclic antidepressants can target faulty nerves and provide pain relief. In more severe cases that do not respond to other treatments, surgery, such as myotomy, may be recommended to weaken the lower oesophageal muscles and reduce spasms.
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Treatment options for oesophageal spasms
Oesophageal spasms are caused by abnormal muscle contractions in the oesophagus, which make it difficult for food and liquid to reach the stomach. They can be painful and cause symptoms such as chest pain and trouble swallowing. If you are experiencing these symptoms, you should seek medical attention.
There are several treatment options available for oesophageal spasms, including:
- Medication: Options include sublingual nitroglycerine, calcium channel blockers (which can help with swallowing), and tricyclic antidepressants, which can target faulty oesophageal nerves and relieve pain. Doctors can also prescribe proton pump inhibitors or H2 blockers, which may help reduce throat spasms.
- Botox injections: Botulinum toxin (Botox) injections temporarily paralyse the oesophagus muscles, stopping spasms. This treatment typically lasts about six months.
- Surgery: If symptoms are severe and other treatments have not been effective, surgery called a myotomy may be recommended. During this procedure, an incision is made along the lower oesophagus muscle to weaken the spasms. However, surgery is generally a last resort.
- Home remedies: Peppermint oil may help relax the oesophageal muscles. Drinking water with a few drops of peppermint oil may relieve minor symptoms. Identifying and avoiding triggers, as well as making lifestyle changes, are often recommended to treat and prevent oesophageal spasms.
It is important to note that oesophageal spasms can be caused by underlying conditions such as depression, anxiety, or GERD, so treating these conditions may also help manage the spasms.
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Tests and diagnosis for oesophageal spasms
Oesophageal spasms are rare but can cause symptoms similar to a heart attack. Therefore, diagnosing oesophageal spasms begins with a patient history and ruling out heart problems. Doctors will first run tests to check heart health and rule out angina, a type of chest pain caused by coronary artery disease. They will also check for signs of gastroesophageal reflux disease (GERD), which can cause heartburn and swallowing difficulties.
The gold standard test for diagnosing oesophageal spasms is oesophageal manometry. This test measures pressure waves inside your oesophagus when you swallow and can delineate the spatial limits, vigour, and integrity of individual contractile segments. Sensors on the tube measure pressure in the oesophagus and reveal how well the muscles relax when you swallow.
Other tests include:
- Barium swallow: You drink a thick, chalky liquid before having an X-ray of your oesophagus. The images show how well the liquid moves from your oesophagus to your stomach.
- Functional lumen imaging probe (FLIP): This newer test provides information about movement within your oesophagus, including its ability to respond to pressure changes.
- Endoscopy: A flexible tube is put down your throat so your doctor can see inside the oesophagus. A biopsy may also be performed during this procedure to rule out other possible diseases.
- Oesophageal pH monitoring: This test indicates if stomach acid is coming back into your oesophagus (acid reflux).
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Frequently asked questions
Esophageal spasms are abnormal contractions of the muscles in the esophagus, the tube that carries food from the mouth to the stomach. These spasms may not move food effectively to the stomach, causing symptoms like chest pain and trouble swallowing.
The exact cause of esophageal spasms is unknown, but they may be related to abnormal functioning of the nerves that control the muscles used for swallowing. Consuming very hot or very cold foods or drinks, or foods that are not chewed enough before swallowing, may trigger a spasm.
Treatment options for esophageal spasms include medication (e.g., calcium channel blockers, nitrates, antidepressants), botulinum toxin (Botox) injections, and, in severe cases that don't respond to other treatments, surgery (myotomy or POEM). Home remedies, such as peppermint oil, may also help relieve minor symptoms.
