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Diffuse Esophageal Spasm


Diffuse esophageal spasm is a rare disorder that makes it hard to swallow foods and liquids. It can sometimes cause non-cardiac chest pain. The esophagus is the muscular tube that moves food or drink from the throat down into the stomach when you swallow. Its muscles produce a wave of coordinated contractions that pushes food down to the stomach.

In diffuse esophageal spasm, these muscle contractions are irregular or uncoordinated, which causes food to get stuck sometimes in the esophagus or to come back up (regurgitation). In some people with diffuse esophageal spasm, the lower esophageal sphincter (LES)—the valve between the esophagus and stomach—does not open and close properly.

The following factors may contribute to or worsen this condition:

  • High blood pressure
  • Anxiety or depression
  • Drinking very hot or cold foods or drinks.

The exact cause of diffuse esophageal spasm is unknown. Some experts think that the nerves that control swallowing may not work well in people with this disorder.

Symptoms

Diffuse esophageal spasm is most common in people between the ages of 60 and 80. People with diffuse esophageal spasms experience one or more of these symptoms:

  • Difficulty swallowing
  • Food coming back up into the throat or mouth
  • Squeezing pain in the chest that feels like heart pain
  • The feeling that food is stuck in the throat.

Diagnosis

If you have symptoms of diffuse esophageal spasm, you will need to undergo testing. In the Esophageal Function Laboratory at Norton Thoracic Institute, you may undergo:

  • Manometry to see if your esophagus contracts abnormally. In this test, a thin tube is passed through your mouth or nose into your esophagus, and measurements are taken as you swallow small amounts of water.
  • Upper endoscopy to examine the inside of your esophagus, lower esophageal sphincter, and stomach. In this procedure, a flexible tube (endoscope) with a light and camera is passed into your esophagus while you are lightly sedated. Tissue samples (biopsies) may be taken during this exam.
  • Esophagram to look for signs of diffuse esophageal spasm, such as a corkscrew esophagus or a tight LES. During this test, you swallow a thick liquid called barium while you undergo an x-ray. The barium allows the physician to see the esophagus and LES clearly.
  • pH testing to check for signs of gastroesophageal reflux disease (GERD). People with GERD experience frequent episodes of reflux, when the contents of the stomach wash back into the esophagus.

Treatment

A number of treatments are available to treat diffuse esophageal spasm:

  • Oral medications to help relax the muscles in the esophagus. These include calcium channel blockers and nitrates.
  • Treatment for any underlying conditions, such as GERD, anxiety, or depression.
  • Botox injections to relax the muscles of the esophagus.
  • A type of surgery called myotomy, which involves an incision in the LES and lower esophageal muscles to reduce esophageal spasms.

Prevention

You cannot prevent diffuse esophageal spasm, but lifestyle changes may help control your symptoms:

  • Avoid foods that seem to trigger your spasms or heartburn.
  • Don't consume food or drink that is extremely hot or cold.
  • Eat slowly and chew your food well.
  • Control stress, since anxiety can contribute to this disorder.

Learn About Services for Esophageal Spasm at Norton Thoracic Institute

To learn more about our services, call 602.406.4000.