esophageal spasm

Epidemiology

uncommon

Pathology

• esophageal muscle contractions of excessive force & duration

Clinical manifestations

• may occur spontaneously
• may be triggered by meals, reflux, physical stress
• pain often persists as a dull ache for hours after the attack
• dysphagia for both liquids & solids
• may respond to nitroglycerin or to calcium channel blockers confounding the differentiation from cardiac angina

Laboratory

• ambulatory monitoring of intraesophageal pH & pressure
• endoscopy may be non diagnostic
• esophageal manometry
  • simultaneous contractions & intermittent normal peristalsis

Radiology

• barium swallow
  • corkscrew esophagus caused by muliple simultaneous esophageal contractions
  • may be non diagnostic

Differential diagnosis

• cardiac angina
• erosive esophagitis
• gastroesophageal reflux disease (GERD)
• heartburn
• achalasia

Management

• empiric trial of aggressive anti-reflux measures (see GERD)
• pharmacologic agents treatment of choice; with limited effectiveness
  • nitrates
  • Ca+2 channel blockers
• trial of bougie dilatation

More general terms

• esophageal dysmotility
• smooth muscle spasm

Additional terms

• chest pain
• esophagus
• gastroesophageal reflux disease (GERD)