esophagus anatomy

What are esophageal spasms and strictures?

An esophageal spasm is a rare disorder characterized by abnormal muscle contractions in the esophagus.

The esophagus is the narrow muscular organ that connects the mouth to the stomach and through which foods and liquids pass after being swallowed. After food is chewed and swallowed, the lump of food moves downward through the esophagus. If the esophagus is functioning normally, peristalsis, or a wave of coordinated contractions, takes place.

However, people with distal esophageal spasm may experience simultaneous contractions in long sections of the esophagus instead of a coordinated wave of contractions. The contractions may be irregular, uncoordinated, or unusually powerful, keeping food or liquids from moving normally down the esophagus.

People who have esophageal spasms may experience:

  • Chest pain which occasionally may be severe enough to be mistaken for a heart attack
  • Difficulty with swallowing (dysphagia) foods or liquids
  • A feeling that something is stuck in the throat

There are two main types of spasms:

  • Diffuse (or distal) esophageal spasms are uncoordinated muscle contractions that occur throughout the lower two-thirds of the esophagus.
  • Nutcracker esophagus is a condition in which the muscle contractions are coordinated but are too strong, causing severe pain.

What is an esophageal stricture?

An esophageal stricture occurs when the esophagus becomes abnormally narrow. Benign (non-cancerous) strictures may occur due to buildup of fibrous tissue and collagen deposits due to ulcers or chronic inflammation of the esophagus.

There are two major types of strictures: simple and complex.

  • Simple is symmetric with a diameter of more than 12 mm.
  • Complex is asymmetric and has a diameter of less than 12 mm.

People with esophageal strictures also have difficulty swallowing solid foods, but generally do not have problems with swallowing liquids.

What causes esophageal spasms and strictures?

No one is sure exactly what causes esophageal spasms. The nerves that regulate peristalsis, the series of muscle contractions in the esophagus, might not work properly. Sometimes spasms are triggered when a person eats hot or cold foods and beverages. However, spasms can also occur in the absence of eating or drinking.

The most common type of esophageal stricture is a peptic stricture resulting from gastroesophageal reflux disease (GERD). Unless it is treated, GERD can cause scarring and narrowing of the lower esophagus. However, now that more effective medications, such as proton pump inhibitors, have been developed to treat GERD, strictures in the lower esophagus resulting from acid reflux are less common.

Strictures may also result from:

  • Radiation treatment for cancer of the head, neck, or chest
  • Surgery to treat esophageal cancer or Barrett’s esophagus
  • Treatment of enlarged veins in the esophagus
  • Swallowing harmful chemicals or objects
  • An allergic condition called eosinophilic esophagitis

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