What is a Diffuse Esophageal Spasm

Symptoms, Diagnosis and Treatment

A diffuse esophageal spasm is difficult to diagnose and even more difficult to treat..The esophagus is the muscular tube that food passes through to get from the mouth to the stomach. The muscles contract in a coordinated way during swallowing in order to move food and liquid to the stomach.  For a person suffering from Diffuse Esophageal Spasms, these muscles contract in an uncoordinated way. As a result, food and liquid that is swallowed does pass as quickly from the mouth to the stomach.  This can lead to some uncomfortable symptoms.

1. Chest pains - Often worse when drinking very hot or very cold liquids.  This pain can be extremely uncomfortable and worrisome since it mimics what one would think of as the pain of a  heart attack.
2. Difficulty in swallowing and a feeling that food is stuck in your chest, sometimes taking hours for the feeling to go away.
3. Some patients may also feel a heartburn type sensation in the center of the chest 

The cause of Diffuse Esophageal Spasms is rarely found but there is a link between Acid Reflux (GERD) and Diffuse Esophageal Spasms.

Diagnosis of the condition can be made by:

1. Barium Swallow Test - The patient swallows a barium "milkshake" while at the same time x-rays are being taken of the esophagus. The x-rays show an uncoordinated esophagus attempting to pass the barium into the stomach.  The esophagus will sometimes have a corkscrew appearance as it contracts.
2. Upper GI Endoscopy - This procedure involves putting a flexible tube with a small camera down the sedated patient's throat so the doctor can see inside the esophagus.  The Upper GI Endoscopy can also detect tumors, scars and any unusual masses.
3. This test is used determine if the esophagus is contracting and relaxing properly. As with the Upper GI Endoscopy, a tube is placed down the patients throat just past the bottom of the esophagus.  While the tube is in place the patients is asked to swallow multiple times with measurements being taken of different parts of the esophagus.

Esophageal spasms are difficult to treat. Treatment options include:

1. Calcium channel blockers
2. Tricyclic antidepressants
3. Nitrates
4. Botulinum toxin
5. A small amount of Peppermint oil can be mixed in water to make the muscles of the esophagus contract normally again.
6. Balloon dilatation is sometimes used. An inflatable balloon is used to increase the diameter of the esophagus.

In extreme cases, surgery to cut the muscles along the lower esophagus is performed. This is considered a major surgery and is only performed in the most serious of cases.

On a positive note, when treated, Diffuse Esophageal spasms are not likely to get progressively worse.  The bad news is they can be difficult to diagnose and even with constant treatment probably will not completely disappear.