Symptoms
Diffuse esophageal spasm manifests as seizure-like pain behind the breastbone (chest pain) and difficulty swallowing. The pain may radiate to the arms and jaw, similar to angina. Other possible symptoms include shortness of breath, cramping and burning. The duration of attacks varies, ranging from seconds to minutes. They are often triggered by food intake, but can occur independently of eating. Very cold or hot foods, emotional stress, and eating quickly are thought to promote the seizures. Histologically, thickening of the muscle layer in the esophagus may be noted.
Causes
Underlying simultaneous smooth muscle contractions in the distal esophagus. These contractions may be due to disturbances in nervous regulation and nitric oxide (NO) or acetylcholine release. The exact cause is unknown.
Diagnosis
The diagnosis is made on the basis of esophageal manometry under specialized medical care. Pain behind the breastbone can be caused by a number of other conditions that must be ruled out at diagnosis. These include, for example, angina, myocardial infarction, inflammation of the pericardium, inflammation of the endocardium, gastric distention, GERD, nutcracker esophagus, and esophagitis. Esophageal achalasia and GERD present very similarly and may occur concomitantly with esophageal spasm.
Nonpharmacologic treatment
If triggers are known, they can be avoided. It is recommended to eat foods that are easy to digest, tend to be liquid, and are not too hot or cold. Endoscopic and surgical methods are mentioned in the literature.
Drug treatment
Medications may relieve symptoms in some cases, but their use is poorly studied scientifically and they may cause adverse effects. A trial of therapy is possible. The use is off-label at the responsibility of the prescribing physician / doctor. Medications are taken either regularly or as needed to coupon the attack: Acid blockers:
Muscle relaxants:
- Nitrates: nitroglycerin, isosorbide dinitrate.
- Phosphodiesterase-5 inhibitors: sildenafil
- Calcium channel blockers: nifedipine, diltiazem
- Botulinum toxin injections
Psychotropic drugs:
- Antidepressants such as trazodone or desipramine affect pain perception.
Taking a few drops of peppermint oil in water is a possible herbal alternative.