Esophageal Spasm: Causes, Symptoms, and Treatment Options
What Is Esophageal Spasm?
Disordered esophageal motility causing uncoordinated, forceful contractions → chest pain and dysphagia (difficulty swallowing). Two main patterns: diffuse esophageal spasm (simultaneous contractions) and nutcracker esophagus (high-amplitude contractions).
Causes and Associations
- GERD (most common trigger)
- Hiatal hernia
- Systemic: diabetes, thyroid disease, scleroderma
- Neurologic: Parkinson's, multiple sclerosis
- Medications: calcium channel blockers, beta-blockers, nitrates (paradoxical)
Symptoms
- Chest pain (often mimics cardiac pain—rule out heart first)
- Dysphagia (solids > liquids)
- Regurgitation, heartburn
- Globus sensation (lump in throat)
Treatment
- Lifestyle: Small meals, avoid triggers (caffeine, alcohol, spicy), head elevation, no late eating.
- Medications: Calcium channel blockers, nitrates, low-dose TCAs (pain modulation), PPIs (if GERD), botulinum toxin injection.
- Procedures: Dilation, POEM (peroral endoscopic myotomy), Heller myotomy (surgical).
Diagnosis
High-resolution manometry confirms; EGD rules out structural causes (stricture, eosinophilic esophagitis, malignancy).
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