EpistemisSensation of esophageal spasm
Specialty: Gastrointestinal.
Why it occurs
- Idiopathic esophageal hyperreactivity to mechanical, thermal or emotional stimuli
- Uncontrolled gastroesophageal reflux that triggers reflex muscle spasms of the esophageal body
- Generalized anxiety disorder or panic attack with transient vagal hyperactivity
- Eosinophil esophagitis in early stages with associated motor dysfunction.
Initial workup
Upper gastrointestinal endoscopy (EDA) with serial esophageal biopsies (to rule out eosinophilic esophagitis and peptic esophagitis) | High resolution esophageal manometry | Complete cardiological rule out (ECG, biomarkers of myocardial necrosis).
red flags
Oppressive retrosternal pain that simulates an acute myocardial infarction (requires urgent cardiac exclusion), progressive dysphagia, odynophagia, significant weight loss or episodes of food impaction that require emergency endoscopic resolution.
Standard management
- Calcium channel blockers — nifedipine 10-20 mg three times a day or diltiazem 60-90 mg three times a day before meals to relax esophageal smooth muscles
- Sublingual nitroglycerin — 0.4 mg administered during the acute spasm episode
- Proton pump inhibitors (omeprazole 20-40 mg daily before breakfast to suppress gastric acidity that triggers reflex spasm).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gastrointestinal
- Listed causes
- 4
- Treatment options
- 3