Esophageal spasm

Diffuse esophageal spasm; Spasm of the esophagus; Distal esophageal spasm; Nutcracker esophagus

Esophageal spasms are abnormal contractions of the muscles in the esophagus, the tube that carries food from the mouth to the stomach. These spasms do not move food effectively to the stomach.

Causes

The cause of esophageal spasm is unknown. Very hot or very cold foods may trigger spasms in some people.

Symptoms

Symptoms may include:

Problems swallowing or pain with swallowing
Problems swallowing
Painful swallowing is any pain or discomfort while swallowing. You may feel it high in the neck or lower down behind the breastbone. Most often, th...
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Pain in the chest or upper abdomen
Pain in the chest
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
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It can be hard to tell a spasm from angina pectoris, a symptom of heart disease. The pain may spread to the neck, jaw, arms, or back

Exams and Tests

Tests you may need to look for the condition include:

Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy
Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine (the duodenum)....
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Esophageal manometry
Esophageal manometry
Esophageal manometry is a test to measure how well the esophagus is working.
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Esophagogram (barium swallow x-ray)

Treatment

Nitroglycerin given under the tongue (sublingual) may help a sudden episode of esophageal spasm. Long-acting nitroglycerin and calcium channel blockers are also used for the problem.

Long-term (chronic) cases are sometimes treated with low-dose antidepressants such as trazodone or nortriptyline to reduce symptoms.

Rarely, severe cases may need dilation (widening) of the esophagus or surgery to control symptoms.

Outlook (Prognosis)

An esophageal spasm may come and go (intermittent) or last for a long time (chronic). Medicine can help relieve symptoms.

Possible Complications

The condition may not respond to treatment.

When to Contact a Medical Professional

Contact your health care provider if you have symptoms of esophageal spasm that don't go away. The symptoms may actually be due to heart problems. Your provider can help decide if you need heart tests.

Prevention

Avoid very hot or very cold foods if you get esophageal spasms.

Open References

References

Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 129.

Pandolfino JE, Kahrilas PJ. Esophageal neuromuscular function and motility disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 44.

Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
Throat anatomy - illustration
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
Throat anatomy
illustration
Esophagus - illustration
The esophagus connects the nose and mouth with the stomach. The epiglottis folds over the trachea when a swallow occurs, to prevent the swallowed substance from being inhaled into the lungs. When a person is unable to swallow because of illness or coma, a tube may be inserted either through the mouth or nose, past the epiglottis, into the esophagus and into the stomach. Nutrients will be passed through the tube directly into the stomach.
Esophagus
illustration

A Closer Look

Talking to your MD

Self Care

Tests for Esophageal spasm

Esophageal manometry

Review Date: 11/3/2022

Health Content Provider

06/01/2025

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Health Library

Esophageal spasm

Spasms

Causes

Symptoms

Problems swallowing

Pain in the chest

Angina

Exams and Tests

Esophagogastroduodenoscopy

Esophageal manometry

Treatment

Outlook (Prognosis)

Chronic)

Possible Complications

When to Contact a Medical Professional