How are esophageal spasms and strictures treated?

There are a variety of methods available for treating simple benign (non-cancerous) esophageal strictures.

Dilation is used to widen the esophageal passageway to relieve dysphagia (difficulty swallowing). The technique uses dilators (long plastic or rubber cylinders of different sizes) to stretch the opening. Dilators with gradually increasing diameters are inserted through the mouth, sometimes over a guide wire.

Balloons may be passed through an endoscope and inflated to stretch the opening. Medication to reduce gastric acid production may be given before the procedure if the stricture is caused by GERD.

Complex strictures are often seen after radiation therapy to treat cancer of the head, neck or chest, or in cases where caustic substances were ingested. In cases for patients with malignant cancer, temporary metal stents (expandable tubes) may be used instead of balloon dilation to keep the esophagus open.

Various treatment options for spasms of the lower (distal) esophagus may include:

  • Oral medications: Calcium channel blockers and nitrates (sublingual nitroglycerin) help to relax the smooth muscle of the lower esophagus. Hyoscamine may also be taken under the tongue to relieve spasms. Sometimes, pain modulators such as tricyclic antidepressants are used to relieve the pain.
  • Botulinum toxin: Injections of botulinum toxin into the smooth muscle of the lower esophagus may inhibit the transmission of nerve impulses, leading to relaxation.
  • Surgery: In some rare cases, patients who do not respond to treatment with medications may have to undergo an operation called a myotomy, in which a long incision is made in the lower esophageal sphincter and muscle to control spasms.
  • Relaxed breathing, biofeedback or hypnosis
  • Warm water: Drinking a glass of warm water may help relieve symptoms in less severe cases.

In most cases, patients can be treated successfully and the disorder will not lead to other serious conditions.

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