Esophageal Spasms – Diagnosis and Treatment
Diagnosis
Healthcare providers use several methods to find out if someone has an esophageal spasm.
- Upper Endoscopy: A doctor inserts a flexible tube with a tiny camera to look inside the esophagus and other parts of the upper gut. The doctor may also collect a small tissue sample (biopsy) to check for other diseases.
- Barium Swallow X-Ray: The patient drinks a special liquid that coats the inside of the esophagus. Doctors then use X-ray images to see the shape and motion of the esophagus. Loose stools may happen for a day or two after this test.
- Esophageal Manometry: This test measures how well the muscles in the esophagus work. It checks the strength and patterns of muscle contractions.
Doctors can find problems like “nutcracker esophagus” or “diffuse esophageal spasm” using this test. High-resolution manometry can provide more detail.
Doctors use these tests to spot abnormal muscle movements or blockages. Sometimes, they use a pH probe to check for acid reflux.
Each test provides different information to help healthcare providers make a full diagnosis.
Treatment
Healthcare providers use several approaches to manage esophageal spasms. The choice depends on how serious and frequent the symptoms are.
Simple changes, such as avoiding very hot or cold foods, can help when spasms are rare.
For more frequent or severe symptoms, doctors may treat other problems that affect the esophagus, like gastroesophageal reflux disease (GERD). Medicines called proton pump inhibitors can reduce stomach acid and may bring relief.
Sometimes, doctors use tricyclic antidepressants such as imipramine to lower pain in the esophagus.
Medications that relax the muscles of the esophagus can also help. These include:
- Calcium channel blockers
- Nitrates (such as isosorbide dinitrate or isosorbide mononitrate)
- Peppermint oil supplements or lozenges
- Botulinum toxin injections into the esophagus
Below is a table with these options:
| Treatment Type | Purpose |
|---|---|
| GERD Management | Reduce acid, ease reflux |
| Antidepressants | Lower pain signals |
| Muscle Relaxants | Reduce muscle spasms |
| Botulinum Toxin Injections | Temporarily block muscle contractions |
If medicine does not control the spasms, doctors may suggest procedures. Dilation (also called dilatation) gently stretches the esophagus and may bring relief.
For severe symptoms that do not improve with medicine, surgery might be an option. Myotomy involves cutting the muscle at the lower end of the esophagus to weaken spasms.
A newer, less invasive surgery called peroral endoscopic myotomy (POEM) uses a scope through the mouth to perform the procedure.
Doctors may consider standard or POEM surgeries if other treatments do not work. Clinical trials may also be available for those interested in new therapies.
Daily Practices and Helpful Habits
People can manage esophageal spasms more easily by making changes at home. Avoiding foods and drinks that trigger symptoms often brings relief. Keeping a diary of what causes discomfort can help identify triggers.
Letting hot or cold foods and drinks cool to a comfortable temperature can prevent irritation. Some people find relief by placing a peppermint lozenge under the tongue, as peppermint oil helps relax muscles.
Getting Ready for Your Visit
Steps to Take Before Seeing the Doctor
Check for any instructions before your appointment. Some visits may require fasting or stopping certain medications.
List all your symptoms, even if they seem unrelated. Include details like how often they happen and what makes them better or worse.
Identify foods or activities that seem to cause symptoms. This is important if reflux or GERD is suspected.
Bring a list of all prescription drugs, over-the-counter medicines, vitamins, and supplements you take.
Summarize your medical history, including any other diagnosed conditions such as autoimmune disorders or eosinophilic esophagitis. Note any treatments you have tried.
Add personal details, such as major life changes, stress, or recent illnesses that could affect your health.
| Item to Prepare | Details/Examples |
|---|---|
| Symptom List | Pain, difficulty swallowing, acid reflux, etc. |
| Medication List | Antacids, PPIs, vitamins, supplements |
| Medical History | GERD, esophagitis, autoimmune disorders |
| Symptom Triggers | Spicy food, large meals, lying down after eating |
Prepare a list of questions to ask during your appointment. Bringing a family member or friend can help you remember information and take notes.
Essential Questions for Your Provider
Consider asking these questions during your visit:
- What could be causing my symptoms?
- Are tests needed, and how should I prepare for them?
- Is my problem likely short-term or ongoing?
- What treatments are available for my condition?
- Are there specific foods or habits I should avoid, especially if I have gastroesophageal reflux, acid reflux, or erosive esophagitis?
- How should I manage my condition if I also have other diseases, like autoimmune problems or eosinophilic esophagitis?
Feel free to add your own questions as you think of them.
What the Medical Team May Ask You
Be ready to answer questions such as:
- When did your symptoms first appear? How severe are they?
- Do your symptoms come and go? Or are they constant?
- What makes your symptoms worse? What helps improve them?
- Does physical activity cause chest pain or discomfort?
- Do your symptoms occur after eating or with certain foods?
- Have you noticed heartburn or a sour taste, which are signs of acid reflux?
- Do you ever wake up at night with pain, heartburn, or a sour taste?
- Have you had trouble swallowing? Have you changed your eating habits because of it?
Your healthcare team uses your answers to find the best way to help you manage your symptoms.
