The esophagus, also commonly known as the food pipe, is a tube that carries the ingested food from the mouth to the stomach. Ingested food along with the saliva is propelled down from this tube with the help of wave-like muscle contractions. This process is medically referred to as peristalsis. Such a series of coordinated wave-like contractions are essential for propelling food from one part of the digestive tract to another. It is therefore a very important part of the digestive process.
In the absence of such sequenced wave-like contractions, the movement of food from the esophagus into the stomach is bound to get affected. The term 'esophageal spasm' refers to the sudden and involuntary contraction of the esophageal muscles.
Diffuse esophageal spasm (DES) and nutcracker esophagus are both sub-types of esophageal spasms and are categorized under esophageal motility disorders. Esophageal spasms are abnormal muscle contractions that affect the sequenced wave-like contractions that facilitate the movement of ingested food from the esophagus into the stomach.
While DES refers to uncoordinated contractions of the esophageal muscles, nutcracker esophagus refers to well-coordinated high-pressure contractions that may take place in the esophagus, irrespective of the presence or absence of food in the food pipe. In this article, we will look into the causes, symptoms and treatment of diffuse or distal esophageal spasms.
Diffuse Esophageal Spasm
Causes and Symptoms
Though the exact cause of DES is still unknown, and this condition is believed to be idiopathic, medical experts believe that inflammation of the esophagus due to the regurgitation of stomach acid towards the esophagus may make one susceptible to this condition. Structural abnormalities such as thickening of the smooth muscle in the esophageal wall or malfunctioning of the lower esophageal sphincter muscle could also put one at an increased risk of developing this condition. It is believed that nitric oxide plays a vital role in facilitating relaxation and contraction of the muscles, and thus, a defect in the nitric oxide pathway, may affect the process of peristalsis.
As far as the symptoms of DES are concerned, one may experience a lump in throat feeling owing to the obstruction of food. Dysphagia or difficulty in swallowing is usually a direct result of abnormal and irregular esophageal contractions. One may also suffer from heartburn and chest pain. As one may face a lot of difficulty in swallowing food, one may even suffer from a loss of appetite.
In absence of timely medical treatment, esophageal spasms could even develop into achalasia. This is a medical condition that is characterized by the failure of the esophagus to relax along with inability of the lower esophageal sphincter to open and propel food down into the stomach. Thus, there is a great need to identify the underlying cause and treat esophageal spasms at the earliest.
Certain medical conditions such as diabetes mellitus, alcoholic neuropathy, amyloidosis, anxiety, scleroderma and acid reflux disease can increase the risk of distal esophageal spasm. It is therefore, essential that diagnostic tests are conducted to formulate a diagnosis. Esophageal manometry, barium swallow radiographic studies, ultrasound and other imaging procedures may be conducted in order to assess the condition of the esophagus. Modification of the diet may prove beneficial in case of patients suffering from acid reflux disease.
Since consumption of very hot or cold foods and beverages can trigger abnormal contractions, the patient must refrain from consuming such food items. When it comes to drug therapy, doctors usually follow a symptomatic approach. Drugs may be recommended for alleviating specific symptoms that the patient might be experiencing. Calcium channel blockers, antidepressants or nitrates may be recommended. If drug therapy is not yielding desired results, botulinum toxin may be injected at the gastro-esophageal junction.
In severe cases, surgery may be recommended for the treatment of a symptomatic diffuse esophageal spasm. The prognosis is good if this condition is diagnosed and treated during the early stages. If treated early, there is a less likelihood of such spasms progressing into achalasia.
Difficulty in swallowing food, chest pain, heartburn and a variety of other symptoms that occur due to this condition can be managed with the help of drug therapy. Modifying one's diet can also help in lowering the incidence of such episodes. In severe cases, surgical procedures such as esophageal dilatation or esophageal myotomy may be required for the treatment of this esophageal motility disorder. As is the case with any medical condition, a timely diagnosis will not only help in the successful management of the symptoms, but also in preventing recurrence of such episodes in future.