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Esophageal Spasm

(Corkscrew Esophagus; Diffuse Esophageal Spasm)

By

Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Last full review/revision Oct 2020| Content last modified Oct 2020
Click here for the Professional Version
Topic Resources

Esophageal spasm is a disorder of the rhythmic waves of muscular contractions (peristalsis) of the esophagus.

  • The cause of this disorder is not known.

  • Symptoms include chest pain and difficulty swallowing.

  • The diagnosis is based on the results of barium swallow x-rays and manometry.

  • Treatment includes calcium channel blockers, injections of botulinum toxin, or sometimes surgery.

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus.)

In this disorder, the normal propulsive contractions that move food through the esophagus are replaced periodically by nonpropulsive contractions or excessive muscular contractions (hyperdynamia) that do not move food through the esophagus.

How the Esophagus Works

As a person swallows, food moves from the mouth to the throat, also called the pharynx (1). The upper esophageal sphincter opens (2) so that food can enter the esophagus, where waves of muscular contractions, called peristalsis, propel the food downward (3). The food then passes through the diaphragm (4) and lower esophageal sphincter (5) and moves into the stomach.

How the Esophagus Works

The exact cause of esophageal spasm is not known but is suspected to be a nerve defect.

Symptoms

Sometimes, esophageal spasm does not cause any symptoms.

When it does cause symptoms, muscle spasms throughout the esophagus typically are felt as chest pain under the breastbone coinciding with difficulty swallowing (dysphagia) liquids (especially those that are very hot or cold) and solids.

Esophageal spasm also may cause severe pain without swallowing difficulty. This pain, often described as a squeezing pain under the breastbone, may accompany exercise or exertion, making it difficult for a doctor to distinguish it from angina (chest pain stemming from heart disease).

Diagnosis

  • Tests to rule out angina

  • Barium swallow x-rays

  • Manometry

Because the chest pain of esophageal spasm is similar to that of angina (chest pain resulting from poor blood flow to the heart), doctors do tests to rule out angina. Tests may include electrocardiography (ECG), exercise stress testing, or other tests.

Doctors do a barium swallow. In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see. This test may show that the barium does not move normally down the esophagus and that some of the contractions of the esophageal wall are uncoordinated and do not move the barium.

Pressure measurements by manometry (a test in which a tube placed in the esophagus measures the pressure of contractions) provide the most sensitive and detailed analysis of the spasms.

Treatment

  • Calcium channel blockers

  • Sometimes injections of botulinum toxin

  • Sometimes surgery

Esophageal spasm is often difficult to treat. Calcium channel blockers such as nifedipine may relieve the symptoms by relaxing the muscles of the esophagus. Tricyclic antidepressants are also used to relax muscles and may also be given.

Other drugs such as nitroglycerin, long-acting nitrates, and drugs with anticholinergic effects (such as dicyclomine) are less successful.

If drugs do not help, a trial of botulinum toxin injections into the lower esophageal sphincter may be tried.

Some people have symptoms that are severe and difficult to treat. Sometimes, a surgeon may cut the muscle layer along the full length of the esophagus (myotomy). Alternatively, a gastroenterologist may cut this muscle layer during endoscopy.

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