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Diffuse Esophageal Spasm

Simultaneous esophageal spasms are uncoordinated contractions of the muscles in the esophagus that – instead of pushing food through to the stomach – are ineffective and prevent normal esophageal movement. Those ineffective diffuse esophageal spasms can be associated with spastic lower esophageal sphincter in around 9 percent of cases.

Causes

It is unclear what causes these poorly coordinated esophageal spasms. However, some common triggers have been identified, like very cold or very hot foods or liquids. Women and patients with baseline anxiety disorders are more prone to diffuse esophageal spasms.

Symptoms

Patients with diffuse esophageal spasm complain of chest pain when the spasms happen. The chest pain can radiate to the jaw or shoulder and can be indistinguishable from heart-related chest pain.  Heartburn and painful swallowing are also common with esophageal spasm. However, when the spasms become frequent they can cause swallowing difficulties and food regurgitation. 

Diagnosis

High resolution manometry or a videoesophagram can demonstrate the ineffective contractions and diagnose diffuse esophageal spasm.  An upper endoscopy might also be necessary to rule out other causes of the symptoms, like chronic gastroesophageal reflux disease or achalasia.

Treatment

Diffuse esophageal spasm is usually a mild disease and might not require any treatment. Prevention by avoiding triggers can be sufficient. In severe cases, smooth-muscle relaxers like sublingual nitroglycerin, as well as long-acting forms of nitroglycerin, can be used. Calcium channel blockers and antidepressants also have been used and can be effective for maintenance therapy. In rare cases, surgery to cut the spastic muscle of the esophagus may be necessary.

By Michel Kafrouni, M.D.

References:

1. Dalton CB, Castell DO, Hewson EG, Wu WC, Richter JE.Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitude contractions. Dig Dis Sci. 1991 Aug;36(8):1025-8.
2. Konturek T, Lembo A. Spasm, nutcracker, and IEM: real or manometry findings? J Clin Gastroenterol. 2008 May-Jun;42(5):647-51.
3. Tsuboi K, Mittal SK. Diffuse esophageal spasm: has the term lost its relevance? Analysis of 217 cases. Dis Esophagus. 2010 Dec 10.