Esophageal Spasms

What are esophageal spasms?

Esophageal spasms are abnormal muscle contractions in your esophagus (the tube that takes food and drink to your stomach after you swallow). These spasms make it harder for food to reach your stomach. They can be painful.

After you swallow, your esophagus muscles contract (flex and relax). When your esophagus works as it should, a wave of coordinated contractions moves food or liquid down to your stomach. This series of contractions is called peristalsis.

If you have esophageal spasms, these contractions don’t work correctly. Unusually powerful or ineffective muscle contractions in your esophagus can make it difficult for food or liquid to move through your esophagus. You may need more time to swallow, or you may regurgitate food.

What are the types of esophageal spasm?

There are two main types:

• Distal (or diffuse) esophageal spasm: Uncoordinated muscle contractions happen mostly in the lower part of your esophagus. This type of esophageal spasm often causes already-swallowed food or liquid to come back up your esophagus (regurgitation).
• Hypercontractile (nutcracker or jackhammer) esophagus: In hypercontractile esophagus, muscle contractions are too strong or forceful. The contractions can cause pain, especially when you swallow. The pain can be severe and may feel like squeezing in your chest.

How common are esophageal spasms?

Esophageal spasms are rare. Medical experts estimate that distal esophageal spasm affects 1 person per 100,000 each year.

What are the symptoms of esophageal spasms?

The two most common symptoms of esophageal spasms are difficulty swallowing (dysphagia) and noncardiac chest pain. But not all cases cause symptoms.

In some cases, esophageal spasms can cause chest pain that feels like you’re having a heart attack. Call your provider or seek immediate medical care if you experience worsening, unexplained chest pain for more than five minutes.

Esophageal spasm symptoms may be mild or severe. They may start at specific times, like after eating. Sometimes, they come on suddenly, out of nowhere. Once spasms start, they may last for a few minutes or more than one hour.

What do esophageal spasms feel like?

If you have esophageal spasms you may have chest pain that feels like:

• Squeezing, tightening, pressure or heaviness, especially behind your breastbone (sternum).
• Heartburn (a burning sensation in your chest).
• Pain on your right side, left side or middle that radiates to your neck, left arm or back.

With dysphagia, you may have:

• The sensation that something is stuck in your throat.
• The feeling that food or liquid is trying to come back up your throat.

What causes esophageal spasms?

Medical experts don’t know the exact cause. But some believe spasms happen because of faulty nerves that control how your esophagus muscles work.

In some instances, the faulty nerves may relate to excess acid in your esophagus. Many people with esophageal spasms also have chronic acid reflux (GERD). With this condition, stomach acid flows back up to your esophagus. It’s possible that the acid damages nerves in your esophagus.

Recent research suggests that people who use opioids for three months or longer are more likely to develop esophageal spasms.

More research is needed to determine the specific cause and risk factors.

What triggers esophageal spasms?

Some people notice esophageal spasm symptoms tend to start:

• After consuming food or (very hot or cold) drinks.
• Before, during or after extreme stress or anxiety.
• During exercise.

But spasms can happen at any time.

How are esophageal spasms diagnosed?

Your healthcare provider will perform a physical exam to evaluate your symptoms. If you have chest pain, your provider may order tests, such as an electrocardiogram (EKG), to rule out heart disease.

Once they’ve ruled out heart disease, they’ll likely perform tests to rule out more common conditions that may be causing your symptoms. These include:

• Upper endoscopy: For this test, your provider will insert a narrow tube called an endoscope into your esophagus. The endoscope has a light and a tiny camera at one end so your provider can view the inside of your esophagus. This test helps your provider see if you have structural irregularities causing your chest pain or trouble swallowing.
• Esophagram (barium swallow): This test requires you to swallow a solution containing barium. Your provider will view X-rays that show the barium moving down your esophagus. It can help a provider rule out other causes of your symptoms, like a stricture (narrowing).

Tests used to diagnose esophageal spasms specifically include:

• Esophageal manometry: This test measures pressure waves inside your esophagus when you swallow. It’s the gold-standard (most used and reliable) test to diagnose esophageal spasms. An unusually large number of simultaneous contractions in your lower esophagus is a major indicator of spasms.
• Functional lumen imaging probe (FLIP): FLIP is a newer test that can provide information about movement within your esophagus. This includes your esophageal wall’s ability to respond to pressure changes.

What can mimic esophageal spasms?

Esophageal spasms can be tricky to diagnose since several conditions cause the telltale symptoms: chest pain and trouble swallowing.

Once your provider determines your issue isn’t heart-related, they’ll rule out more common digestive system conditions with similar symptoms. These may include:

• GERD (which often happens alongside esophageal spasms).
• Esophageal strictures.
• Hiatal hernia.

How are esophageal spasms treated?

Esophageal spasm treatments focus on relaxing your esophageal muscles to relieve your symptoms. If esophageal spasms don’t cause symptoms, you may not need treatment.

Your healthcare provider may recommend any of the following to treat esophageal spasms:

• Home remedies: Research shows that peppermint oil may help relax esophageal muscles. Drinking water with a few drops of peppermint oil may relieve minor symptoms. Identifying what triggers your symptoms could help you avoid future spasms.
• Medication: Taking calcium channel blockers (blood pressure medicine) before eating helps many people swallow more easily. Taking nitrates can help relieve chest pain. Tricyclic antidepressants can target the faulty esophageal nerves, relieving pain.
• Botulinum toxin (Botox®) injections: Botox injections temporarily paralyze your esophagus muscles, stopping spasms. If other therapies haven’t helped, your provider may recommend this option. Treatment benefits last about six months.
• Surgery: If your symptoms are severe and other treatments haven’t helped, your provider may recommend surgery called a myotomy. During a myotomy, a provider makes an incision along your lower esophagus muscle. This incision stops the muscle from working entirely, which stops abnormal contractions. With the esophageal muscle no longer in use, gravity moves food and liquid down your esophagus.

Many people with esophageal spasms and GERD experience symptom relief for both conditions by taking proton pump inhibitors (PPIs). These medicines reduce stomach acid production.

Esophageal spasms related to opioid use often resolve after you stop taking them.

Can I prevent esophageal spasms?

Unfortunately, you can’t prevent the condition from happening altogether. Still, identifying and avoiding potential triggers (like certain foods or drinks) may help prevent spasm episodes from starting or worsening.

Are esophageal spasms serious?

Esophageal spasms sometimes cause chest pain or trouble swallowing. But providers don’t consider the condition a serious threat to your health. Having trouble swallowing may make you worry about choking, but esophageal spasms aren’t life-threatening. Usually, they don’t interfere with your ability to get adequate nutrition.

Esophageal spasms don’t increase your risk of esophageal cancer or other serious conditions that can affect your esophagus.

What is the prognosis (outlook) for people with esophageal spasms?

The prognosis of esophageal spasms varies based on the severity of your symptoms. Many people experience few or minor symptoms from esophageal spasms. Treatments improve esophageal spasm symptoms considerably.

Your healthcare provider will monitor you to ensure any medications you take are working. They’ll schedule follow-up appointments post-surgery to ensure you’re healing as you should be.

When should I see my healthcare provider?

Esophageal spasms can sometimes cause symptoms similar to a heart attack. A heart attack can be life-threatening if not treated right away. Call 911 or seek immediate medical care if you experience:

• Heaviness or tightness in your chest that doesn’t go away after five minutes.
• Pain in other areas near your chest, such as your shoulder, arm or neck.
• Trouble catching your breath (called dyspnea).
• Heart palpitations, such as fast or irregular heartbeat.
• Dizziness or feeling faint or weak (like you might pass out).
• Cold sweats.
• Nausea or vomiting.

Heartburn-like pain and trouble swallowing are often signs of a routine problem. Still, they may signal a more serious condition (such as cancer). Always check in with your provider if you experience similar symptoms for longer than two weeks.

What questions should I ask my healthcare provider?

Questions to ask include:

• What’s likely causing my spasms?
• How can I identify potential triggers?
• What treatments would you recommend?
• What treatment side effects should I expect?
• How long will I need treatment and monitoring?

A note from Cleveland Clinic

Left untreated, moderate to severe cases of esophageal spasms can negatively impact your quality of life. Symptoms may make eating, which should be an enjoyable activity, difficult. Chronic pain may lead you to withdraw from activities you enjoy or take an emotional toll. If heartburn, trouble swallowing or other esophageal spasm symptoms are causing trouble, ask your provider about treatment options. Always seek immediate medical care when you have unexplained chest pain.