Esophageal Spasm.docx
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EsophagealSpasm
Esophagealspasms
Introduction
You'rereallythirstyandyoutakeahugegulpofacold,carbonatedbeverage.Suddenly,youexperienceaseverepaininyourmidchestthatletsupafteracoupleofseconds.Thisisoneformofanesophagealspasm.Insomepeople,esophagealspasmsoccurwithmuchgreaterfrequencyandcanleadtochronicswallowingproblemsandpain.
Youresophagusisalongtube-likestructurethatconnectsyourthroattoyourstomach.Ahealthyesophagusmovesfoodintoyourstomachthroughaseriesofcoordinatedmuscularcontractions,calledperistalsis.Esophagealspasmsdisruptthisprocess.
Esophagealspasmsareanuncoordinatedseriesofmusclecontractionsthatpreventfoodfromtravelingproperlyfromyouresophagustoyourstomach.Thesespasmscanbeverypainful.Chestpainisacommonsymptomofesophagealspasms.
Thecauseofesophagealspasmsisunknown.Esophagealspasmsaremorecommoninpeoplewithacidrefluxdisease,andyourlikelihoodofdevelopingtheconditionincreaseswithage.
Treatmentofesophagealspasmsintheshorttermmayinvolveusingmedicationstoquicklyrelaxtheesophagealmuscles.Long-termtreatmentmayinvolvemanaginganycontributinghealthcondition,takingadditionalmedications,alteringyoureatinghabits,andotherapproaches.
Signsandsymptoms
Esophagealspasmsaffectthesmooth(involuntary)musclesinthewallsofyourloweresophagus.Thesespasmsmayoccurintwoforms:
∙Diffusespasms.Thesesimultaneousorirregularcontractionsofesophagealmusclesslowdowntheprogressoffoodtowardyourstomach.
∙Nutcrackeresophagus.Foodmayprogresstoyourstomachnormally,butthecontractionsofyouresophagealmusclesarepainfullystrong.
Forbothformsofesophagealspasms,periodsofcontractionsoftenoccurintermittently,becomingmoresevereoveraperiodofyears.
Signsandsymptomsofesophagealspasmsinclude:
∙Paininyourchest,oftenintense,whichyoumightmistakeforheartpain(angina)
∙Difficultyswallowing(dysphagia)
∙Painfulswallowing
∙Thefeelingthatanobjectisstuckinyourthroat(globus)
∙Bringingfoodbackup(regurgitation)
∙Heartburn,aburningsensationthatmayradiatefromyourupperabdomentoyourneck,sometimesleavingasourtaste
Esophagealspasmscanbedifficulttodiagnosebecauseoftheirsimilaritywithotherdisorders,suchasgastroesophagealrefluxdisease(GERD),aconditioninwhichstomachacidorbileflowsback(refluxes)intoyouresophagus,irritatingitslining.
Causes
Theexactcauseofesophagealspasmsisunknown.Somepossibilitiesinclude:
∙Extremelyhotorextremelycoldfoods,althoughhowthesefoodsmaytriggerthespasmsisunclear
∙Gastroesophagealdisease(GERD)orheartburn,conditionsaffectingtheesophagusandwhichmaytriggerspasms
Riskfactors
Esophagealspasmsaremorecommoninwomen,andtheincidenceincreaseswithage.Ifyouhavegastroesophagealrefluxdisease,youmaybemorepronetoesophagealspasms.Yourdoctormaytestyouforrefluxortryamedicationtargetedatacidreflux.
Whentoseekmedicaladvice
Ifyouhavedifficultyswallowing,chestpain,frequentheartburnordifficultykeepingfooddown,seeyourdoctor.
Screeninganddiagnosis
Yourdoctormayconfirmadiagnosisofesophagealspasmsbythesemethods:
∙Bariumswallow(esophagram).Thisisthebestimagingstudytohelpdiagnoseesophagealspasmsandacommontestforpeoplewhohavedifficultyswallowing.AbariumswallowusesaseriesofX-raystoexamineyouresophagus.Duringthetest,you'lldrinkathickliquid(barium)thattemporarilycoatstheliningofyouresophagussothattheliningshowsupclearlyonX-rayimages.Youmayalsohaveairblownintoyouresophagus,tohelppushthebariumagainsttheesophaguswalls.
Afterthetest,youcaneatnormallyandresumeyourdailyactivities,althoughyou'llneedtodrinkextrawatertohelpflushthebariumfromyoursystemandpreventconstipation.
∙Esophagealmotility(manometry)test.Inthistest,yourdoctorinsertsathintubethroughyournoseormouthintoyouresophagustomeasuretheeffectivenessofyouresophagealmusclesintheswallowingprocess.
∙Esophagealcomputerizedtomography(CT)scan.CTscansuseanX-ray-generatingdevicethatrotatesaroundyourbodyandapowerfulcomputertocreatecross-sectionalimages,likeslices,oftheinsideofyourbody.Thistestmayshowabnormalthickeningofyouresophagealmuscles,apossibleindicatorofesophagealspasms.
Treatment
Treatmentmayinclude:
∙Managinganyunderlyingconditions.ConditionssuchasheartburnorGERDmaytriggerspasms.
∙Behaviormodification.Yourdoctororadietitianmaysuggestapproachesrangingfromchangingyoureatinghabits(forexample,avoidingmealsbeforebedtime)tochangingyourdiet(avoidingcertainfoods,suchasspicyoracidicfoods).
∙Biofeedback.Inthismethod,youusethepowerofyourmindtocontrolyourbody.Abiofeedbacktherapistconnectselectricalsensorstoyourbodytohelpyourecognizeandcontrolyourbody'sphysiologicalresponsetostress.Thistreatmentoptionisavailableinmanyphysicaltherapyclinics,medicalcentersandhospitals.
∙Medications.Smoothmusclerelaxants,suchascalciumchannelblockersornitrates,canreducetheseverityofcontractions.Yourdoctormayalsoprescribetricyclicantidepressants,suchastrazodoneandimipramine,toreducepain.Newertreatments,suchaspeppermintoilandsildenafil,haveshownpromiseinsmallstudies.Inasmallnumberofpeople,directinjectionofbotulinumtoxinalsohasshownsomebenefit.
∙Surgery.Inrarecases,surgerymaybeanoptiontomakeesophagealcontractionsweaker(myotomy)ortoremoveyouresophagusentirely(esophagectomy).
Prevention
Yourdietmayhaveadramaticeffectonreducingesophagealspasms.Payattentiontowhichfoodsseemtocausethespasms.
Avoidinghot,coldorspicyfoods,largemeals,orfoodswithahighacidcontent(suchasfruitjuice,chocolateandtomatoes)maydecreasetheoccurrenceofspasms.
DiffuseEsophagealSpasm
Theesophagusisamusculartubethatconnectsthemouthtothestomach.Duringswallowing,itcontractsinacoordinatedwaytomovefoodorliquidtothestomach.
Diffuseesophagealspasmcausestheesophagustocontractinanuncoordinatedway.Asaresult,whatisswallowedisnotpusheddownintothestomach.
Symptoms
Between80to90percentofthepeoplewiththisconditionhavechestpain.Thepainoftenstartsorworsenswheneatingordrinkingveryhotfoodsorliquids,anditmayfeelsimilartothepainofaheartattack.
Othersymptomsincludedifficultyswallowingandmorethanhalfofpatientswiththisconditionexperiencethefeelingoffoodgettingstuckinsidethecenterofthechest.Patientsmayalsofeelaburningsensationinthecenterofthechest(heartburn).
CausesandRiskFactors
Diffuseesophagealspasmscanbecausedbydisruptionsordamagetothenervesthatcoordinatethemusclesoftheesophagus.Insomecases,thisconditioncanleadto
achalasia.
Diagnosis
Thisconditioncanbediagnosedusing:
∙Abariumswallow.X-raystakenoftheesophaguswhilethepatientswallowsbariumshowanuncoordinatedesophagusthatsometimeslookslikeacorkscrew.Uncoordinatedcontractionsmaykeepthebariumfrommovingtothestomach.
∙Esophagealmanometry.Thistestidentifieswhenthemusclesaretightening(contracting)withoutbeingcoordinated.
∙UpperGIendoscopyisalmostalwaysperformedifapatientdescribesfoodstickingintheesophagusafterswallowing.Thisprocessinvolvesputtingaflexibletubewithatinycameradowntheindividual'sthroatsothatthedoctorcanseeinsidetheesophagus.Thisprocedurecanbehelpdetecttumors,unusualmassesorscars.
Treatment
Treatmentoptionsinclude:
∙Botulinumtoxin(BoTox®).Botulinumtoxinisapoisonproducedbythebacteriathatcausebotulism.DuringupperGIendoscopy,asmallamountofthissubstancecanbeinjectedintothemuscledoesnotrelaxtoblockthefunctionofnervesthatmakethemusclecontract.Thisproceduremayneedtoberepeated.
∙Drugstorelaxthemuscles.Whilemedicationscanhelpsomepatients,theyarenoteffectiveoverall.
∙Peppermintoil.Asmallamountmixedinwatermakesthemusclesoftheesophaguscontractnormallyagain.
∙Surgerytocutthemusclesalongtheloweresophagus.Thisprocedureisusuallyperformedonlyinseriouscasesthatdonotrespondtoothertherapy.
EsophagealSpasm
Background:
Broadly,esophagealspasmcanbesubdividedinto2distinctentities:
(1)diffuseesophagealspasm(DES),inwhichcontractionsareuncoordinated,and
(2)nutcrackeresophagus,inwhichcontractionsproceedinacoordinatedmanner,buttheamplitudeisexcessive.
Symptomscanincludedysphagia,regurgitation,andnoncardiacchestpain.Becauseofthevaguesymptomsanddifficultyindiagnosis,esophagealspasmoftenisnotdiagnosedandisundertreated.Manypatientswithmanometricandradiologicaberrationsmaynothaveanyappreciablesymptoms.
Currently,manometryisthebestdiagnosticmodality.Treatmentincludescalciumchannelblockers,botulinumtoxin,nitrates,tricyclicantidepressants,dilatation,myotomy,andesophagectomy.Researchisongoingtounlocktheunderlyingcausestoimproveourdiagnosticcapabilitiesandtherapeuticregimensinthefuture.
Pathophysiology:
Theesophagusiscomprisedof2layersofmuscle,theinnercircularandtheouterlongitudinallayers.Arbitrarily,theesophaguscanbedividedinto3zones,eachwithseparateyetintegratedanatomyandphysiology.
Esophagealzones
Upperzone:
Comprisedentirelyofstriatedmuscle,thiszoneinitiatesthecontractionsthatpropelthefoodbolusdownth