Esophageal Spasms

Overview

What are esophageal spasms?

Esophageal spasms are abnormal muscle contractions in the esophagus (the tube that connects your throat to your stomach). These spasms make it harder for food to reach your stomach. They can be painful.

What is the esophagus?

The esophagus is a muscular tube that makes up part of your digestive system. It takes food or drink to your stomach after you swallow.

How does the esophagus work?

The muscles that make up the esophagus work together in intricate ways. Sphincters (muscular valves) at both ends of the esophagus open and close to let food and drinks pass from your mouth to your stomach. These valves also stop food or liquid from coming back up your esophagus (such as from the stomach) for no reason.

After you swallow, esophagus muscles contract (flex and relax). When the esophagus works as it should, this 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 the esophagus can make it difficult for food or liquid to move through your esophagus.

Is there more than one type of esophageal spasm?

Esophageal spasms can affect muscles in your esophagus differently. The two main types are:

  • Diffuse (or distal) esophageal spasm: Uncoordinated muscle contractions happen mostly in the lower part of the esophagus. This type of esophageal spasm often causes already swallowed food or liquid to come back up your esophagus (called regurgitation).
  • Nutcracker esophagus: This similar condition also affects how the esophagus muscles work. In nutcracker (or jackhammer) esophagus, muscle contractions are too strong or forceful. This 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 diffuse esophageal spasm affects one in 100,000 people.

Symptoms and Causes

What causes esophageal spasms?

The precise cause of esophageal spasms is unknown. Some in the medical community believe the problem results from faulty nerves that are responsible for how the esophagus muscles work. Too much acid in the esophagus could also lead to the problem. Excess acid can be due to having heartburn for a long time.

Some people notice esophageal spasm symptoms after eating hot or very cold food or drink. But spasms can happen anytime, even when you’re not eating or drinking.

What are the symptoms of esophageal spasms?

Esophageal spasms can cause mild to severe symptoms. Some people experience no 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.

The symptoms of esophageal spasms usually come and go. You may notice symptoms at certain times, such as after eating or drinking something very hot or cold. Or symptoms may come on suddenly, out of nowhere. Symptoms 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 may feel like heartburn (burning sensation in the chest) or, less commonly, a heart attack.
  • Trouble swallowing foods or liquids (dysphagia).
  • Pain near the breastbone when you swallow or at other times.
  • Sensation that something is stuck in your throat.
  • Food or liquid comes back up after you swallow it (regurgitation).

Diagnosis and Tests

How are esophageal spasms diagnosed?

Esophageal spasms can be tricky to diagnose. Your healthcare provider will first physically examine you to evaluate your symptoms. If you have chest pain, your provider may order tests, such as electrocardiogram (EKG), to rule out heart disease.

Other tests that help diagnose esophageal spasms include:

  • Barium swallow: This test requires you to swallow a solution containing barium. X-rays are taken while the barium moves down your esophagus. If a stricture (narrowing) is present, the barium may become stuck or slows down.
  • Endoscopy: In this test, if your provider suspects that a structural abnormality is present, a narrow tube called an endoscope is inserted into your esophagus. The endoscope has a light and tiny camera at one end so your provider can view the inside of your esophagus.
  • Esophageal manometry: If no structural abnormality is detected, this test is performed to measure pressure waves inside the esophagus. The presence of unusually large numbers of simultaneous contractions in the lower esophagus is the major indicator of spasms.

Management and Treatment

How are esophageal spasms treated?

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

Treatments include:

  • Home remedies: Research has shown that peppermint oil may help calm 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: Medication can treat esophageal spasms in different ways. Taking calcium channel blockers (blood pressure medicine) before eating helps many people swallow more easily. Tricyclic antidepressants can target the faulty esophageal nerves, relieving pain.
  • Botulinum toxin (Botox®) injections: Botox injections temporarily paralyze the esophagus muscles, stopping spasms. If other therapies haven’t helped, your provider may recommend this option. Treatment benefits usually last one year.
  • Surgery: For severe cases, your provider may recommend surgery to fix the problem permanently. During a myotomy surgery, a provider makes an incision along the lower esophagus muscle. This incision stops the muscle from working entirely, which stops abnormal contractions. With the esophageal muscle no longer in use, gravity helps move food and liquid into the esophagus.

Prevention

Can I prevent esophageal spasms?

Unfortunately, because researchers have not uncovered what causes esophageal spasms, you can’t prevent the condition from happening altogether. Still, identifying what triggers your symptoms (such as certain foods or drinks) may help you keep symptoms from starting or getting worse.

Outlook / Prognosis

Are esophageal spasms dangerous?

Esophageal spasms can be disruptive. They sometimes cause pain or trouble swallowing. But the condition isn’t considered a serious threat to your health. Esophageal spasms are not known to cause esophageal cancer.

Heartburn-like pain and trouble swallowing are often signs of a routine problem (such as GERD, or chronic acid reflux). Less commonly, these symptoms 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 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 can often improve esophageal spasm symptoms considerably. Reach out to your provider if you have trouble swallowing or persistent heartburn.

Living With

When should I call the doctor?

Esophageal spasms can sometimes cause symptoms that look very 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.

A note from Cleveland Clinic

Left untreated, moderate to severe cases of esophageal spasms can negatively affect your quality of life. Symptoms may make eating difficult, which can lead to nutrition imbalances over time. 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 limit how much you get out of life, ask your provider about treatment options. Always seek immediate medical care when you have unexplained chest pain.

Last reviewed by a Cleveland Clinic medical professional on 11/03/2020.

References

  • Goel S, Nookala V. Diffuse Esophageal Spasm. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Accessed 10/27/2020.
  • Merck Manuals. Manometry. Accessed 10/27/2020.
  • Merck Manuals. Esophageal Spasm. Accessed 10/27/2020.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy