Esophageal Spasm

Esphageal spasm is a medical condition in which there is a sudden,painful contraction of the lower esophagus.

The esophagus is a tube that connects the mouth to the stomach and allows the passage of food to the stomach.

In esophageal spasm there is irregular,uncoordidinated and sometimes powerful contractions which can make it difficult to swallow food.

Esophageal spasm is a rare disease and usually occurs in people in who are their 60's.

The symptoms seen in esohageal spasm can be very similar to other conditions such as gastroesophageal reflux disease (GERD) or achalasia (a condition in which the muscles of esophagus and the lower esophageal sphinter do not work properly which to problems with nerves).

The pain experienced in esophageal spasm can be intense and usually lasts from a few seconds to minutes. Treatment is not required in most cases but if food gets stuck in esophagus,treatment is required.

The symptoms of esophageal spasm include: difficulty swallowing sometimes related to specific substances like red wine or very hot or cold food, chest pains, regurgitation (process in which contents of the stomach move into the esophagus),heartburn and a feeling of food being stuck on the throat.

These symptoms tend to be inteemittent and may occur with or without food.

Many patients may not have any symptoms and problems with the esophagus can only be revealed after esophageal manometry studies.

The pain experienced can be severe and thus most patients are more likely to confuse it with heart pain (angina).

The exact cause of esophageal spasm is unknown. Many doctors believe it is caused by the disturbance in the nerve activity that coordinates the swallowing action of the esophagus.

Very hot or very cold drinks have been shown to be triggers. Sometimes spasms can be spontaneous ( without any trigger).

Other possible causes of esophageal spasm include :GERD and esophageal wall thickening.

There are two types of esophageal spasm: Occasional contractions (difuse esophageal spasm) which is accompanied by pain and reguergitation of food or liqids from the stomach to the esophagus and painfully strong contractions (nutcracker esophagus) which is painful but is usually not accompanied by regurgitations of food or liquids.

In order to diagnose esophageal spasm the following tests may be performed:

• Manometry - a tube is carefully passed into the esophagus and the stomach.This tube has sensors that measure the pressure in the esophagus. The pressure shows the strength of the esophagus when a person swallows.

Other tests are : endoscopy and X-ray imaging with barium swallow.

In endoscopy a long tube with a camera at the end (scope) is inserted into the esophagus to chreck the shape of the esophagus. The thickness of the esophagus can also be checked. Samples of the esophagus can also be taken for laboratory investigations.

In an X-ray imaging a patient is given barium swallow which helps the esophagus and stomach to show up better on the x-ray.

The treatment of esophageal spasm is usually to reduce spasms, pain and help to improve swallowing.

Medication can be given for pain and to relax smooth muscles of the esophagus.

Botulin toxin injections can be given to relax the smooth muscles and thus help in reducing the spasma and pain.

Proton pum inhibitors may also be given to reduce reflux of stomach contents into the esophagus.

Surgery is often required in severe cases of esophageal spasms.

Surgical procedures include: dilatation in which dilators are inserted into the esophagus to widen the esophagus and myotomy where the muscles of the esophagus ars cut to widden the area and allow food and liquids to move into the stomach more easily.

There are no clear ways to prevent esophageal spasm since the events that trigger the spasms are poorly understood.

However, avoiding very hot and very cold drinks or food can help reduce the frequency of the spasms.

Controlling stress has also been shown to be effective.

Since GERD has been linked to esophageal spasm, taking measures that treat this condition such as reducing alcohol intake, avoiding spicy and fatty foods and quitting smoking can be very helpful.

Alternative remedies used for esophageal spasm include:

• biofeedback,
• relaxation therapy.

Biofeedback is a therapy in which a therapist helps a patient to better react to stress or pain.Electrodes are placed on different parts of the body ,such as the chest, to monitor the body's responses. This can help the patient know how to reduce pain or spasms.

In relaxation therapy a patient is taught how to feel less physical and emotional stress. Deep breathing, muscle relaxation and music are some of the forms of relaxation therapy.

Avoiding the consumption of very hot or cold foods can help patients to cope with esophageal spasm.

Esophageal spasms may be more common or more severe when a person is stressed.

Placing a peppermint lozenge under the tongue usually helps since peppermint oil is a smooth-muscle relaxant and might help ease esophageal spasms.

There are several risks and complications associated with esophageal spasm.

The risk factors for esophageal spasm are :

• being over the age of 60,
• having GERD,
• having high blood pressure,
• anxiety or depression,
• taking very hot or cold food or drinks.

The potential complications seen in esophageal spasm are based on the therapy used.

All the medications used have possible side effects and patients should be carefully monitored.

Esophageal perforation can occur in esophageal dilatation and myotomy leading to admission to the hospital and possible surgery.If a perforation occurs, it should be closed immediately to prevent further complications.

Other complications are vaus nerve injury ,postoperative infections, atelectasis, pneumonia and persistant air leak.