Esophageal spasm: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | [[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | ||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | [[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | ||
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*Strong spasms of the musculature of the esophagus that can last minutes to hours and mimic the chest pain of angina | *Strong spasms of the musculature of the esophagus that can last minutes to hours and mimic the chest pain of angina | ||
*Unclear what causes esophageal spasm. Possibly related to food intolerance. | *Unclear what causes esophageal spasm. Possibly related to food intolerance. | ||
==Clinical Features== | ==Clinical Features== | ||
*Squeezing or tightening pain in the chest | *Squeezing or tightening pain in the chest | ||
*Can have associated [[dysphagia]] +/- globus sensation | *Can have associated [[Special:MyLanguage/dysphagia|dysphagia]] +/- globus sensation | ||
*Can be triggered by eating hot or cold drinks/food. | *Can be triggered by eating hot or cold drinks/food. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Chest Pain DDX}} | {{Chest Pain DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*Esophageal spasm is a diagnosis of exclusion. Work-up should focus on ruling out more serious etiologies. | *Esophageal spasm is a diagnosis of exclusion. Work-up should focus on ruling out more serious etiologies. | ||
**[[ECG]] | **[[Special:MyLanguage/ECG|ECG]] | ||
**CBC | **CBC | ||
**Chemistry | **Chemistry | ||
**[[Troponin]] | **[[Special:MyLanguage/Troponin|Troponin]] | ||
**[[CXR]] | **[[Special:MyLanguage/CXR|CXR]] | ||
*Consider: | *Consider: | ||
**[[BNP]] | **[[Special:MyLanguage/BNP|BNP]] | ||
**PT/PTT | **PT/PTT | ||
**[[D-dimer]] vs. CTA chest | **[[Special:MyLanguage/D-dimer|D-dimer]] vs. CTA chest | ||
===Diagnosis=== | ===Diagnosis=== | ||
*Diagnosis of exclusion | *Diagnosis of exclusion | ||
*Upper gastrointestinal endoscopy with esophageal biopsies obtained to rule out other causes | *Upper gastrointestinal endoscopy with esophageal biopsies obtained to rule out other causes | ||
*Followed by esophageal manometry | *Followed by esophageal manometry | ||
==Management== | ==Management== | ||
*Step-wise approach to therapy is recommended | *Step-wise approach to therapy is recommended | ||
#Pharmacologic therapy focused on controlling GERD symptoms | #Pharmacologic therapy focused on controlling GERD symptoms | ||
#Trial of peppermint oil before meals<ref>Peppermint oil improves the manometric findings in diffuse esophageal spasm.<https://pubmed.ncbi.nlm.nih.gov/11418786/></ref> | #Trial of peppermint oil before meals<ref>Peppermint oil improves the manometric findings in diffuse esophageal spasm.<https://pubmed.ncbi.nlm.nih.gov/11418786/></ref> | ||
#Trial of [[Calcium channel blockers]] | #Trial of [[Special:MyLanguage/Calcium channel blockers|Calcium channel blockers]] | ||
#If the above are not successful consideration of [[Tricyclic antidepressants]] | #If the above are not successful consideration of [[Special:MyLanguage/Tricyclic antidepressants|Tricyclic antidepressants]] | ||
==Disposition== | ==Disposition== | ||
*Outpatient GI referral and work-up | *Outpatient GI referral and work-up | ||
==See Also== | ==See Also== | ||
*[[Chest pain]] | |||
*[[Achalasia]] | *[[Special:MyLanguage/Chest pain|Chest pain]] | ||
*[[Special:MyLanguage/Achalasia|Achalasia]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
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Latest revision as of 22:53, 4 January 2026
Background
- Strong spasms of the musculature of the esophagus that can last minutes to hours and mimic the chest pain of angina
- Unclear what causes esophageal spasm. Possibly related to food intolerance.
Clinical Features
- Squeezing or tightening pain in the chest
- Can have associated dysphagia +/- globus sensation
- Can be triggered by eating hot or cold drinks/food.
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Evaluation
Workup
- Esophageal spasm is a diagnosis of exclusion. Work-up should focus on ruling out more serious etiologies.
- Consider:
Diagnosis
- Diagnosis of exclusion
- Upper gastrointestinal endoscopy with esophageal biopsies obtained to rule out other causes
- Followed by esophageal manometry
Management
- Step-wise approach to therapy is recommended
- Pharmacologic therapy focused on controlling GERD symptoms
- Trial of peppermint oil before meals[1]
- Trial of Calcium channel blockers
- If the above are not successful consideration of Tricyclic antidepressants
Disposition
- Outpatient GI referral and work-up
See Also
External Links
References
- ↑ Peppermint oil improves the manometric findings in diffuse esophageal spasm.<https://pubmed.ncbi.nlm.nih.gov/11418786/>