Esophageal Spasms

Esophageal spasms are uncomfortable muscle contractions in the muscular tube that connects your mouth to your stomach. The esophagus is the name of this tube. Esophageal spasms might mimic a brief period of intense, persistent chest discomfort that lasts for hours. Some individuals could confuse it for angina, which is a type of heart discomfort.

Esophageal spasms normally happen infrequently and may not require medical attention. Yet, on occasion, the spasms are frequent and might obstruct the passage of food and drinks via the esophagus. There are therapies available if your ability to eat or drink is hampered by esophageal spasms.

An uncommon esophageal motility problem called diffuse esophageal spasm (DES) is characterized by synchronous, random, or quickly disseminated spasms of normal amplitude with dysphagia. Manometrically, it is described as concurrent contractions of the esophageal smooth muscle with an amplitude larger than 30 mmHg that alternate with normal peristalsis in more than 20% of moist swallows.

The definition of DES has been modified since the development of high-resolution esophageal pressure topography and now includes the presence of at least two premature contractions with a distal latency of fewer than 4.5 seconds within the context of normal esophagogastric junction relaxation.

Esophageal Spasms: Causes

It is uncertain what causes diffuse esophageal spasms. Several theories have been put forth.

Peristalsis is disrupted, which is most likely caused by an imbalance between the inhibitory and excitatory postganglionic pathways. In the distal portion of the esophagus, which makes up about two-thirds of the esophagus in DES, there is muscular hypertrophy or hyperplasia. Although the exact cause is uncertain, increased acetylcholine release might play a role. Some hypotheses include that the peristaltic irregularities observed in DES may be caused by nitric oxide-mediated reduction of inhibitory ganglion neuronal activity, gastric reflux, or a primary nerve or motor problem.

While heartburn can cause esophageal contractions, exposure to acid can also cause esophageal spasms. There have also been reports that blood glucose and body mass index (BMI) are parameters that are predictive for the function of the lower esophageal sphincter, whereas total cholesterol and BMI are indicators that have a high predictive value for esophageal contractility.

Esophageal Spasms: Symptoms

The patient with esophageal spasms mainly presents with the following symptoms that include −

• The dysphagia that can affect both meals and liquids is the most obvious and acute symptom of DES.

• Globus hysteric is a condition where the patient experiences a feeling of something becoming caught in the back of the throat.

• Non-cardiac chest discomfort that presents retrosternal, is of undetermined origin, and may radiate to the back. Less than 10% of cases of noncardiac chest discomfort are caused by it. In rare cases, it may even exhibit considerably more severe symptoms than typical anginal traits.

• Individuals with DES may also occasionally regurgitate their unfinished meals.

• Heartburn may result from the connection of DES with GERD, which can occasionally make a diagnosis difficult.

There have also been reports that blood glucose and body mass index (BMI) are parameters that are predictive for the function of the lower esophageal sphincter, whereas total cholesterol and BMI are indicators that have a high predictive value for esophageal contractility.

Esophageal Spasms: Risk Factors

Several factors play an important role in the development of esophageal spasms which includes −

• Their blood pressure is high.

• Deal with despair or anxiety.

• Ingest red wine.

• Sip on hot or cold beverages.

Esophageal Spasms: Diagnosis

The diagnosis of the esophageal spasms is mainly done based on history and some tests may be required for confirmation and to rule out underlying causes −

• Manometry of the esophagus. This test evaluates your lower esophageal sphincter's ability to relax or open during swallowing, as well as the rhythmic muscular contractions that occur in your esophagus when you swallow.

• An esophagram, or X-rays of your upper digestive tract. Once you consume a chalky substance that covers and fills the inside lining of your digestive system, X-rays are performed. Your esophagus, stomach, and upper intestine may all be seen in silhouette by your doctor thanks to the coating.

• The upper endoscope. To view the interior of your esophagus and stomach, your doctor places a thin, flexible tube down your throat that is fitted with a light and camera. The name of this device is an endoscope. Endoscopy can also be utilized to obtain tissue samples for examination for the presence of further esophageal disorders. A biopsy is a term for this piece of tissue.

Esophageal Spasms: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Your esophageal spasms' frequency and intensity will determine how you should be treated. If you just sometimes experience spasms, your doctor may first advise avoiding excessively hot or cold meals to see if that helps.

Your doctor could advise the following if your spasms make it difficult for you to eat or drink −

• Addressing any underlying issues. Sometimes, illnesses like gastroesophageal reflux disease or heartburn are linked to esophageal spasms (GERD). A proton pump inhibitor may be suggested by your doctor to treat GERD. Antidepressants like imipramine may occasionally be administered. This medication could be able to lessen esophageal discomfort.

• Medications that relax the muscles in your throat. Spasms can be less severe with the use of peppermint oil, botulinum toxin A injections, or calcium channel blockers like diltiazem.

• Endoscopic myotomy of the mouth (POEM). POEM is a minimally invasive technique. An endoscope is inserted into your mouth and down your throat using this modern method. This enables a surgeon to make an incision in your esophageal lining.

Surgical Treatment

Surgery (myotomy). Your doctor can suggest a treatment that involves cutting the muscle at the lower end of the esophagus if the medication doesn't relieve your symptoms. The myotomy technique can aid in reducing esophageal spasms.

As there is no long-term research on this method, myotomy is often not advised for treating esophageal spasms. If alternative therapies don't work, they could be taken into consideration. POEM is often only considered if other therapies fail, the same as normal myotomy.

Esophageal Spasms: Prevention

Some of the measures that can help to prevent esophageal spasms include −

• Prevent being triggered. List the meals and drinks that make your esophageal muscles spasm.

• A warm or chilly meal is preferable. Before eating or drinking, give hot or cold foods and beverages some time to cool down.

• Suck on a peppermint stick.

Conclusion

Chest discomfort and dysphagia are typically the first symptoms of diffuse esophageal spasm. The origin is currently unclear, although it can occasionally also appear with regurgitation and heartburn.

The majority of the patient's medical care is handled by a general practitioner and nurse practitioner, but refractory cases and patients who need surgery should be managed by a professional team that includes an internist, gastroenterologist, radiologist, and general surgeon.

To deliver the greatest treatment and improve the likelihood of a successful outcome, a comprehensive interprofessional team approach involving doctors, specialists, specialty-trained nurses, and pharmacists must interact across their disciplines.