Diffuse Esophageal Spasm: Causes, Symptoms, and Treatment

Introduction:

Diffuse esophageal spasm is a rare motility disorder of the esophagus, characterized by uncoordinated or rapid propagated contractions that are of normal amplitude and are also accompanied by difficulty in swallowing. It may lead to symptoms similar to heart disease, and in many cases, the cause of diffuse esophageal spasm remains unknown. This condition leads the esophagus to contract in an uncoordinated way resulting in restriction in food passing to the stomach. Some typical cases occasionally occur and require no treatment, but when the spasm increases and prevents food or liquid from traveling in the esophagus, treatment is required.

What Causes Diffuse Esophageal Spasm?

The causes of esophageal spasms are not clear. They are related to abnormal functioning of nerves that control muscles that help in swallowing. A healthy esophagus normally moves food through the stomach through a series of coordinated muscle contractions. Spasms make it difficult for the muscles in the walls of your lower esophagus to coordinate in order to move food in the stomach. There are two types of diffuse esophageal spasm:

• Distal esophageal spasm.

• Hypercontractile esophagus or jackhammer esophageal spasm.

What Are the Factors That Worsen Diffuse Esophageal Spasm?

The factors that may contribute to worsening the condition are:

• Anxiety or depression.

• High blood pressure.

• Drinking very cold or hot foods or drinks.

What Are the Signs and Symptoms of Diffuse Esophageal Spasm?

Diffuse esophageal spasm is most common in individuals between the ages of 60 and 80. Individuals with diffuse esophageal spasm experience one or more than one of the following symptoms:

• Difficulty swallowing solids and liquids, related to swallowing specific substances like red wine or extremely cold and hot liquids.

• The feeling of food or objects is stuck in the throat.

• Return of food and liquid regurgitation.

• Squeezing chest pain. Pain is intense, and it might be mistaken for heart pain (angina).

What Are the Typical Clinical Features of Diffuse Esophageal Spasm?

The typical clinical feature of individuals with diffuse esophageal spasm are:

1. The main clinical feature of diffuse esophageal spasm is dysphagia (difficulty in swallowing).

2. Globus hystericus is a condition, in which the individual presents with a feeling of an object trapped on the back of the throat.

3. Chest pain which is non-cardiac in nature has the possibility to radiate to the back. The record states that ten percent of cases are accounted for noncardiac chest pain.

4. Occasional complaints of regurgitation of the undigested food.

5. Gastroesophageal reflux disease (GERD), along with diffuse esophageal spasm can be a challenging condition to diagnose.

How Is Esophageal Spasm Diagnosed?

The diagnosis of esophageal spasm is made by the following tests:

• Esophageal Manometry: Rhythmic contractions of the esophagus are measured while swallowing by this test. The coordination and force exerted are recorded and tests on how well the sphincter muscle relaxes and opens during a swallow.

• Upper Endoscopy: A thin, flexible tube with a camera head and equipped light is inserted into the esophagus via the mouth and this allows examination inside the esophagus. It also allows the taking of a sample of tissue for external examination. This procedure is known as a biopsy.

• X-Rays: X-rays of the upper digestive tract are taken, and a chalky substance is asked to drink that coats and fills the lining of the tract. This allows the physician to view the silhouette of the esophagus, stomach, and upper intestine.

Newer techniques like high-resolution manometry and esophageal topography have enhanced the ability to diagnose diffuse esophageal spasm. Studies using high-frequency catheters using ultrasound imaging have shown increased baseline muscle thickness in individuals with diffuse esophageal spasms. To get a clear picture of a disease like diabetes that can present with similar symptoms should be ruled out using blood glucose and hemoglobin A1c (HbA1C) levels.

What Is the Treatment for Diffuse Esophageal Spasm?

Esophageal spasm treatment focuses on relaxing the esophageal muscles and this relieves the symptoms. Esophageal spasms do not cause symptoms and may need no treatment.

Treatment includes:

• Home Remedies: Research shows peppermint oil helps to calm and relieve the esophageal muscles. Consuming water along with a few drops of peppermint oil may relieve minor symptoms, and identifying triggering symptoms can help to avoid future spasms.

• Medication: Calcium channel blockers before eating help many individuals swallow more easily. Tricyclic antidepressants target faulty esophageal nerves, which relieve pain.

• Botulinum Toxin Injections: These injections temporarily paralyze the esophagus muscle, which stops spasms. When other therapies do not work, this option is recommended. Treatment benefits usually last for a year.

• Surgery: In severe cases, the provider may recommend surgery to fix the issue. During myotomy surgery, an incision along the lower esophagus muscle. Incision stops the muscle from working entirely and stops abnormal contractions. As the esophageal muscle is no longer in use, gravity helps move liquid and food in the esophagus.

What Is the Differential Diagnosis of Diffuse Esophageal Spasm?

Differential diagnoses of diffuse esophageal spasm are:

• Achalasia (a rare disease causing difficulty in swallowing food and liquid through the esophagus).

• Scleroderma (a chronic disorder causing tightening and hardening of the skin and connective tissues).

• Vascular anomalies.

• Chagas disease (an infectious disease caused by a protozoan parasite present in the triatomine bug feces).

• Hypertensive low esophageal sphincter (LES).

• Esophageal stricture.

• Esophageal motility disorder.

• Gastroesophageal reflux (GERD).

• Esophagitis (inflamed esophagus)

• Esophageal webs and rings.

• Ineffective esophageal utility.

• Myocardial infraction.

Conclusion:

Diffuse esophageal spasm is mostly associated with chest pain and difficulty in swallowing. Sometimes it is also associated with regurgitation and heartburn as well. A general health care provider and nurse practitioner are mostly involved in the management of the individual with diffuse esophageal spasm. Educating about the condition of the affected individual leads to timely follow-up and medication compliance that helps in minimizing morbidity and enhances the quality of life. The prognosis of diffuse esophageal spasm is moderate due to marked elevated symptoms over three years. Possible complications associated with wound infection, pneumonia, and atelectasis (complete or partial collapse of the lung or a portion of the lung) should be kept on high clinical suspicion and should be addressed properly.