Diffuse esophageal spasm is the term used by experts to describe a mostly chronic movement disorder of the esophagus. In technical language, this disorder is called ‘motility disorder. In this case, there are repeated seizure-like muscle contractions of the esophagus, and pain may also occur at the sternum. The exact causes of diffuse esophageal spasm are not clear.
What is diffuse esophageal spasm?
Diffuse esophageal spasm is a sudden, strong, spasmodic contraction of the muscles in the esophagus. The smooth muscle is always affected. These contractions mostly occur in the middle and lower part of the esophagus. They have no propelling effect for food and can cause pain behind the breastbone. It is a stabbing cramping sensation. This pain can also radiate down the shoulder and jaw to the arms, and sometimes to the back. Usually, this discomfort comes on very suddenly. It may also be accompanied by difficulty swallowing. The problems usually occur very suddenly and unexpectedly and can either be triggered by swallowing or occur spontaneously.
Causes
The causes of diffuse esophageal spasm are not known to date. It mostly affects older people, but young people can also suffer from this condition. However, diffuse esophageal spasm is associated with certain underlying diseases. Affected individuals often suffer from one of the following conditions: Diabetes mellitus, collagenoses, central and peripheral nervous system diseases, muscular diseases, amyloidoses, and alcoholism. Simultaneous contractions of the smooth muscles of the esophagus are responsible for the symptoms. These muscle contractions are associated with disturbances in nervous regulation and nitric oxide release. However, these findings are not substantiated.
Symptoms, complaints, and signs
This disease is associated with various complaints, but they can occur in different degrees. In any case, they have a very negative impact on the patient’s quality of life and limit it considerably. As a rule, patients suffer from pain that occurs directly behind the breastbone. In particular, this pain can be intensified by the ingestion of food and liquids, so that many patients deliberately take less food and liquids. This leads to difficulty swallowing and further to dehydration and various deficiency symptoms. In some cases, the disease can also lead to respiratory distress, so that the patient’s resilience drops and physical exertion can no longer be carried out easily. Many sufferers are dependent on a special diet to prevent the symptoms of this disease from worsening. However, if diagnosed at an early stage, the disease usually progresses positively and there are no particular complications. Furthermore, the disease can also have a negative effect on the psychological state of the affected person and possibly lead to depression or other psychological upsets. Usually, the life expectancy of the affected person is not reduced.
Diagnosis
Diffuse esophageal spasm can be diagnosed by several methods. First, the physician will conduct a detailed history-taking interview with the patient to discuss all symptoms in detail. The patient should describe in detail exactly which complaints occur, how often they occur, how long they last and whether they have existed at all. This makes it much easier for the doctor to decide which further examinations are appropriate in the case in question. An X-ray examination is very often used to diagnose diffuse esophageal spasm. The use of a contrast medium is necessary to obtain a useful result. The patient swallows a piece of bread soaked in barium. The exact course of the piece of bread through the esophagus is then observed. Irregular and corkscrew-like deformations of the esophagus can be detected in this way. A similar examination procedure is the so-called porridge swallow method, in which a porridge mixed with contrast medium is ingested.
Complications
The disease can cause various symptoms and complications of the esophagus.In most cases, these manifest themselves in the form of swallowing difficulties, so that it is usually no longer possible for the patient to take in normal food and liquids. The quality of life is thus extremely reduced and everyday life becomes more difficult for the patient. It is not uncommon for this to result in underweight or dehydration, both symptoms representing a very unhealthy condition for the patient. Furthermore, acute respiratory distress may also develop and severe pain is experienced by the patient. Diagnosis of the disease usually occurs without complications and relatively quickly, so that treatment can be started early. The treatment itself is also usually without complications, during which various medications are used. In some cases, the permanent intake can trigger an addictive behavior. For the patient, however, the diet also changes, so that fatty foods or alcohol must be avoided. For psychological complaints, antidepressants are used to treat the effect of the painkillers. Life expectancy is not usually reduced by the disease.
When should you see a doctor?
If there is pain behind the breastbone, difficulty swallowing, and other signs of diffuse esophageal spasm, a visit to the doctor is recommended. If dehydration or underweight has already occurred due to the symptoms, this must be clarified immediately. Especially in case of shortness of breath and severe pain, a quick examination by the family doctor is indicated. In the event of a severe course – if the affected person can no longer breathe reasonably or signs of pneumonia are noticed – relatives should contact the emergency medical service. After treatment, close monitoring by the responsible physician is indicated. Depending on the severity of the condition, physiotherapeutic support may also be sought to restore the previous quality of life. Diffuse esophageal spasm often occurs in association with diabetes mellitus, collagenoses, muscular and nervous diseases, amyloidoses, and alcoholism. In the presence of relevant preexisting conditions, signs of esophageal movement disorder should be promptly evaluated. The elderly and severely ill should have diffuse esophageal spasm and other diseases ruled out during annual screening examinations.
Treatment and therapy
As a rule, treatment of diffuse esophageal spasm is performed with purely medicinal agents. Medications such as acid blockers, muscle relaxants, and psychotropic drugs are considered. Especially muscle relaxants usually show a very good effect. By relaxing the muscles in the esophagus, the cramping and painful attacks are avoided. Taking antidepressants can also have a positive effect on the sensation of pain and provide general relaxation. Sometimes, however, there are causes of diffuse esophageal spasm that do not require drug treatment. For example, the complaints can arise when drinking alcohol and due to incorrect eating behavior. Then it helps to avoid the triggering substances and to arrange the daily meals differently. Conscious eating is very helpful here. Sufficient time should be allowed for each meal; gulping down food quickly promotes problems in the esophagus. Likewise, each bite should be chewed thoroughly before the food is swallowed. This makes it easier for the esophagus to move the food down the stomach, but it also makes it easier for the stomach to digest well chewed food. Relaxation exercises such as yoga, meditation or autogenic training can be very helpful and improve the symptoms of diffuse esophageal spasm. If all attempts at therapy do not help, surgery may be performed as a last resort. However, surgery is very rarely performed for diffuse esophageal spasm. The surgical procedure in question is called a myotomy. It involves splitting the esophageal muscles, but it is essential to leave out the lower part of the muscles. Otherwise, there is a risk of reflux disease.
Outlook and prognosis
The prognosis of diffuse esophageal spasm is determined by the underlying disease present and its severity. In a large number of cases, there is a good prospect of cure. In many patients, relaxation techniques are sufficient to achieve long-term relief of symptoms.Particularly in the case of triggers such as stress or emotional tension, balancing exercises and training can be used to relax the entire musculature. If diffuse esophageal spasm is caused by alcohol consumption, the prognosis is also favorable. With the discontinuation of consumption, freedom from symptoms occurs. If alcohol addiction exists, it must be treated to achieve recovery. In the case of incorrect eating behavior, chewing procedures are specifically trained with the patient. This leads to relief or spontaneous healing of the disease. If freedom from symptoms is not achieved by the means described, medication is administered. These relieve existing cramps and alleviate the existing pain. As soon as the underlying disease is cured, the drugs are no longer needed because the patient has recovered. In the worst case, surgical corrections are made, which ultimately lead to an optimal swallowing act. Only rarely do sequelae persist. Diffuse esophageal spasm may recur at any time. The prognosis remains optimistic if recurrence occurs. Healthy eating habits and good mastication lower the recurrence rate.
Prevention
There is no direct way to prevent diffuse esophageal spasm. Psychological disorders can be the trigger, as well as improper food intake. Therefore, it is important to ensure inner balance and to organize meals consciously. It is important to chew sufficiently and to have enough time to eat. Gulping down large pieces of food is not beneficial for the muscles of the esophagus. Despite these precautions, diffuse esophageal spasm can occur in anyone.
Follow-up
There are usually very few, if any, follow-up care measures available to the affected person with this disease. In this case, the affected person is primarily dependent on early detection of the disease. This is the only way to avoid further complications and complaints, which, if left untreated, will lead to a further worsening of the symptoms. The earlier the disease is detected, the better is usually the further course. Therefore, the focus is on early diagnosis. The disease is usually treated by taking medication. The affected person should in any case ensure that the medication is taken regularly and correctly, and should also observe the correct dosage. If there are any questions or uncertainties, a doctor should always be consulted first so that no further complaints arise. Furthermore, a healthy lifestyle with a healthy diet can also have a positive effect on the further course of the disease. The affected person should avoid fatty or very sweet foods and eat light food. Various therapies can also help to relieve the symptoms of the disease. Further measures of aftercare are usually not necessary in this case.
What you can do yourself
One characteristic of diffuse esophageal spasm is that the strong and spontaneous contractions of the esophageal smooth muscle are not directed. This means that they do not transport any food that may be in the esophagus. A reason for the spontaneous and often painful contractions is usually not apparent. They are contractions with a contraction wave that occur independently of the directed motility during swallowing. Because the etiology of the contractions that occur is usually unknown, but eating habits, excessive alcohol consumption and psychological factors are often held responsible, those affected can achieve improvements by adjusting their behavior in everyday life and by self-help measures – also accompanying any drug treatment. Above all, eating behavior and – if applicable – alcohol consumption behavior should be critically reviewed and adjusted if necessary. This also includes reviewing the daily menu. The food consumed should be as easily digestible as possible, contain natural components such as vegetables and fruit, and contain few hard-to-digest components such as high-fat products of animal origin. Since it is very likely that the psyche also plays a not insignificant role in the development of diffuse esophageal spasm, the regular use of relaxation techniques such as yoga, autogenic training and meditation as a self-help measure can help to overcome the disease.