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Esophageal Spasms


Disease: Esophageal Spasms Esophageal Spasms
Category: Digestive diseases

Disease Definition:

One form of esophageal spasm occurs when someone takes a huge gulp of a cold, carbonated beverage and they suddenly experience a severe pain in their mid-chest, which lets up after a couple of seconds. In some cases, esophageal spasms could cause chronic swallowing problems and pain.


Esophageal spasms, which could be quite painful, are an uncoordinated series of muscle contractions that prevent food from traveling properly from the esophagus to the stomach. One of the common symptoms of an esophageal spasm is chest pain. In the short term treatment of esophageal spasms, medications are used in order to quickly relax the esophageal muscles, while the long term treatment involves managing the contributing health conditions, altering eating habits and taking additional medications.

Work Group:

Symptoms, Causes


The involuntary muscles in the walls of the lower esophagus are affected by esophageal spasms. These spasms usually occur in two forms:


Diffuse spasms:

The progress of food toward the stomach is slowed down by the simultaneous or irregular contractions of esophageal muscles.


Nutcracker esophagus:

Although food might progress to the stomach normally, however, the contractions of the esophageal muscles are painfully strong. This type of esophageal spasm doesn’t cause difficulty swallowing as much as diffuse spasm does.


Usually, periods of contractions occur intermittently in both forms of esophageal spasms. Some of the signs and symptoms of esophageal spasms are:


  • Dysphagia, meaning difficulty swallowing
  • Regurgitation, which means bringing food back up
  • The feeling that an object is stuck in the throat (globus)
  • Pain in the chest, usually intense, which could be mistaken for angina
  • Heartburn, which is a burning sensation that radiates from the upper abdomen to the neck and sometimes leaves a sour taste in the mouth.


Esophageal spasms are similar to other disorders, such as GERD (gastroesophageal reflux disease), a condition in which stomach acid or bile flows back into the esophagus, irritating its lining. Because of this similarity, esophageal spasms are difficult to diagnose. Someone should see a doctor in case they experience difficulty swallowing, frequent heartburn, difficulty keeping food down or chest pain.


The esophagus, a long tube-like structure, connects the throat to the stomach. Through a series of coordinated muscular contractions called peristalsis, a healthy esophagus moves food into the stomach. This process is disrupted due to esophageal spasms. Although the exact cause of esophageal spasms is not known yet, however, there are some possibilities:


Heartburn or GERD (gastroesophageal disease):

Spasms may be triggered by these conditions that affect the esophagus.


Extremely hot or extremely cold foods:

These foods trigger spasms; however, it is not clear exactly how.





Some of the treatment options for esophageal spasms include:



The severity of contractions may be reduced with smooth muscle relaxants, such as nitrates or calcium channel blockers. The patient may also be prescribed antidepressants to reduce pain, including trazodone and imipramine. When esophageal spasms are being treated solely, these medications are given in lower doses than those needed to treat depression. When other treatments have failed, the patient may try an injection of botulinum toxin into the esophagus, although this treatment has shown some benefit, however, doctors approach it with caution. In some small studies, newer treatments, such as silenafil and pepperminto oil have shown promise.


Behavior modification:

The patient may be advised avoiding large meals and eating slowly. Also, the dietitian or doctor might suggest avoiding very hot or very cold foods.


Managing any underlying conditions:

Spasms may be triggered by conditions such as GERD or heartburn. The likelihood of developing esophageal spasm symptoms lessen in case these conditions are treated. Esophageal spasms may also be relieved when underlying psychological disorders, such as depression or anxiety are treated.



In some rare cases, surgery could be an available option in making esophageal contractions weaker (myotomy) or removing the esophagus entirely (esophagectomy).


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