Diffuse Esophageal Spasm

What is diffuse esophageal spasm?
Diffuse esophageal spasm is a disorder pertaining to the movement (motility) of the esophagus and can disrupt normal swallowing ability or cause chest pain in some patients. Typical symptoms include sensations of choking or trouble swallowing and chest discomfort.

How is diffuse esophageal spasm diagnosed?
Eliminating the possibility of other causes for symptoms such as acid reflux disease, other esophageal motility disorders or narrowing of the esophagus is important to be sure the correct treatment is started.

  • Barium swallow studies (thick barium contrast solution is swallowed to see esophagus structures by x-ray and potentially note reflux of stomach contents).
  • Esophageal manometry (measures esophageal pressures and swallowing ability).
  • A small measuring device (Bravo capsule) can be placed in the lower esophagus by upper endoscopy or through the mouth to record acid events over a 48 hour period. The device has special sensors that measure how often you have acid backing up into your esophagus and how long it stays there. Alternatively, a 24-hour pH monitoring test is also available. During the 24-hour test, a thin tube is placed through the nose and into the esophagus. The tube remains in place for 24 hours and the information is recorded on a small computer monitor.
  • Upper endoscopy or EGD (esophagogastroduodenoscopy) is a procedure where a small lighted tube is passed through your mouth into the esophagus, stomach and first portion of the small intestine. This test allows the doctor to see the lining of your upper GI tract and take biopsies (tissue samples) if needed.

What causes diffuse esophageal spasm?
This problem can be caused by simultaneous contractions of the esophagus (dysmotility). This is mostly seen in the lower esophagus just above the stomach. In addition, an area of specialized muscle tissue called the lower esophageal sphincter (LES) could be too tight, making it difficult for food or liquids to pass into the stomach. The LES is located at the junction of the esophagus and the stomach. The job of the LES is to act as a one-way valve, allowing food to enter the stomach and prevent it from coming back up into the esophagus. Esophageal hypersensitivity (discomfort experienced with normal esophageal processes due to an increased awareness or heightened nerve sensitivities) can also occur.

What are the treatments for diffuse esophageal spasm?
Esophageal dysmotility and pain can be responsive to changes in eating habits such as the avoidance of extreme temperatures with foods and beverages, eating slowly and chewing food well. In addition, medications (by mouth or by injection into the LES) can be used to relax muscle contractions or reduce nerve sensitivities that lead to pain. Lastly, if symptoms persist despite the above recommendations, surgery to directly cut the muscle fibers of the LES may be helpful.

When to seek medical advice?
If chest pain should change location, duration, character (type of pain) or becomes more severe, seek medical advice as soon as possible as this could indicate a new or more serious problem. If trouble swallowing does not improve with treatment or should worsen, please call your doctor for advice.