The esophagus or the food pipe comprises of the upper part of the gastrointestinal tract and is located between the oral cavity and the stomach. The upper esophageal sphincter controls the movement of food and drinks from the oral cavity into the esophagus, while the lower sphincter controls the movement of food and drinks from the esophagus into the stomach.
Esophageal spasm is a gastrointestinal motility disorder which affects the esophagus. This condition is associated with problems in muscular contractions, resulting in spasms and interfering with the normal movement of food through the esophagus. There are two basic forms of esophageal spasms,
- Diffused esophageal spasms are characterized by uncoordinated contractions across different sections of the esophagus. Clinically this condition is defined as presence of 20% of swallows with simultaneous contractions in distil esophagus.
- Nutcracker esophagus which is characterized by coordinated but high amplitude contractions. Clinically this condition is defined as normal peristalsis with average distal esophageal amplitude of more than 180mmHg (which is 40 mmHg higher than normal).
Experts suggest that esophageal spasms are often associated with gastroesophageal reflux disease and the presence of this condition can amplify the manifestation of the symptoms.
What Causes Esophageal Spasm?
While the pathophysiology for the condition is not clearly understood, it is believed to be associated with defects in nitric oxide pathways or abnormalities in neurotransmitters controlling the distal part of the esophagus.
There are reports which have indicated that this condition is frequently present in association with other conditions like anxiety, depression, alcoholic neuropathies, scleroderma, amyloidosis and diabetes mellitus.
While this condition can affect individuals of all ages, the condition is frequently observed in individuals above the age of 50 years.
Esophageal Spasm Symptoms
Esophageal spasms are associated with a few specific symptoms,
- Non cardiac chest pain: Typically the chest pain may be confused with angina pectoris due to the close proximity of the esophagus with the heart. Further sudden rise in pressure in the esophagus may lead to crushing and severe retrosternal pain, but unlike angina pectoris, doesn’t radiate to the left arm or back.
- Dysphagia or inability to swallow food is another characteristic symptom.
- Esophageal spasms are also often associated with other symptoms like heartburn, regurgitation of food, etc. Hoarseness of voice and coughing may also be observed when the larynx is irritated by regurgitated acid content.
Treatment For Esophageal Spasms
Since the manifestation of the condition is associated with similarities with a host of other medical conditions, it becomes imperative to first confirm the diagnosis before initiating treatment. A series of investigations comprising of esophageal motility studies, esophageal provocation tests and pH studies are conducted. Barium swallow tests and ultrasounds may also be performed to confirm the diagnosis.
Occasionally ECG and Doppler studies may also be performed to rule out cardiac conditions. Once the diagnosis is confirmed the treatment regimen is started. Some of the key modalities for treatment include the following,
- Dietary modification is the key. The patient is recommended to avoid hot or cold foods. Also small quantities of food should be taken instead of a heavy meal. Liquids and soft diet is preferred over a solid diet.
- Surgical intervention comprising of botox injections or esophageal dilatation may be attempted.
- Homeopathic drug Lycopodium is considered of great value in management of peristalsis related disorders.