Esophageal spasm

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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

Emergent

Nonemergent

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
  1. Pharmacologic therapy focused on controlling GERD symptoms
  2. Trial of peppermint oil before meals[1]
  3. Trial of Calcium channel blockers
  4. If the above are not successful consideration of Tricyclic antidepressants

Disposition

  • Outpatient GI referral and work-up

See Also

External Links

References

  1. Peppermint oil improves the manometric findings in diffuse esophageal spasm.<https://pubmed.ncbi.nlm.nih.gov/11418786/>