Diseases

Esophageal Spasm: The definitive guide

Its almost like a heart attack. Understand more about this extremely painful and incapacitating condition.

Story Highlights

  • Esophageal spasms are extremely painful and incapacitating. It is often caused as a result of a damaged Gastrointestinal/Digestive system.
  • It affects 1 in 100,000 people in the US, each year.
  • Vagus nerve damage, Anxiety/Depression, GERD symptoms, Abnormal peristalsis are thought to be the underlying causes.
  • Esophageal manometry is the most preferred diagnosis method.
  • Mostly, Esophageal spasms are curable with lifestyle changes and better food habits.
I am sure you will agree if I say that Esophageal spasm is probably one of the most uncomfortable and painful conditions one can have.

However, there is hope! What if I say that there is a cure for most people who suffer from Esophageal spasms. Unfortunately, like all good things in life, it’s not like flipping a switch, there is definitely some amount of effort involved to cure esophageal spasms. Are you ready for the information you have been waiting for, right from the day you suffered through your first spasm attack?

In this comprehensive article, we will try to understand in general about esophageal spasms, immediate relief options, causes, diagnosis and treatment options, the usual triggers,  natural remedies and lifestyle changes that may eventually cure this dreadful condition.

Have you ever experienced these symptoms – feeling like food is stuck in your throat, regurgitation, intense painful (feels like a squeezing pain) vibrations in the chest area that may radiate to back, arms and jaws. These are hallmark symptoms related to esophageal spasms. A severe esophageal spasm attack is a truly helpless feeling as you cannot sit, stand or lie down and you might be literally rolling with the pain. You may even feel it’s a heart attack due to the similarity in the pain profile. Esophageal spasms are considered to be benign and non-progressive. However, if you are experiencing these symptoms, it is highly advisable to visit your doctor for diagnosis immediately to rule out any cardiac related complications.

How to stop Esophageal Spasm (Immediate reliefs)?

For our readers looking for an immediate relief, these tips may help alleviate the pain or may even stop the spasm on its tracks. Read audience poll for other tips that worked for our readers. Note that these may or may not work for you. Use your judgement when trying any of the mentioned quick remedies.

  • Drink water: If you are suffering from Nutcracker esophagus (and you have the kind of spasm where you can actually drink something during a spasm), drinking a glass of lukewarm water quickly in a single breath during the start of the attack may stop it. Note that this may not work for people suffering from diffuse esophageal spasms as they will not be able to swallow anything during the spasm and water or food may regurgitate. Caution: This can be a very painful affair and might not even work for some people.
  • Yoga: Downward dog position of yoga elongates the esophagus and seems to help stop spasms.
  • Breathing exercise: Try deep breathing to help the esophagus relax.
  • Elongate your esophagus: Stretch your arm straight up in the air, bend your elbow and put your hand on the back of your neck, making sure to keep your bicep close/on your head.
  • Burp: Try to burp and release some gas.
  • Lying on your tummy: If you are feeling bloated during the spasm attack, lying on your tummy is a good way to help your body release some gas. For some people, it is seen that once some gas is released, symptoms start to disappear.
  • Relaxing warm shower: Warm bath to relax the chest muscles, preferably under a massaging shower head so that you can do some focused water massage on your chest area.
  • Peppermint oil: It helps reduce the intensity and irregularity of the contractions in the esophagus during an attack. You can pour 5 drops of peppermint oil (not essential oil) in 10 ml water and drink it. If you spasm does not allow you to swallow, just pour 5 drops of peppermint oil near the back of your tongue.
  • Peppermint lozenges: On the go, peppermint oil or tea may not be viable options. Lozenges can help in such situation. Have a pack of peppermint lozenges handy so that you can quickly pop one under the tongue when you feel the onset of a spasm. Buy USDA organic Peppermint lozenges.
  • Lavender oil: It is known to relax the muscles due to its antispasmodic, analgesic and anti inflammatory properties. You can pour 5 drops of lavender oil (not essential oil) in 10 ml water and drink it. If you spasm does not allow you to swallow, just pour 5 drops of lavender oil near the back of your tongue.
  • Skullcap: Skullcap is a popular herb which is a good muscle relaxant and is effective in treating muscle disorders.
  • Cayenne pepper: Cayenne helps alleviate pain by blocking neurotransmitters that trigger the feeling of pain. If your spasm allows you to swallow, mix 0.5 tsp Cayenne pepper to 6 Oz of fresh juice and gulp it down.
  • Apple Cider Vinegar (ACV): If your spasm allows you to swallow, mix 1 tsp ACV to 1 glass lukewarm water and gulp it down. Even if it does not stop the spasm immediately, it will help balance the acidity in the stomach and prevents further spasms. Purchase Braggs Organic ACV with ‘mother’.
  • Nitroglycerin: Another option often recommended by doctor is sublingual Nitroglycerin given under the tongue. It helps relax the smooth muscles of the lower easophagus. (Not highly regarded due to its interactions and side effects. Check with your doctor about it.)

For more natural remedies, continue reading.

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The complicated process of swallowing

In order to understand esophagus spasms, we need to look at how we swallow our food. We will skim through some of the major touch points in the process.

The Esophagus and Sphincters

Esophagus is the long (approx. 8 inches) muscular tube connecting the throat and stomach. You can refer to the video (above) to understand how the food is pushed through the esophagus into the stomach. In the video, you will notice that the contraction waves are initiated by the act of swallowing and these coordinated and rhythmic waves pushes the food from the throat to the stomach. The video also briefly mentions the upper and lower esophageal sphincters that acts as ‘valves’. Swallowing relaxes these sphincters and allows food into the stomach.

The Vagus Nerve

Vagus nerve is one of the most important nerve in the human body and it controls major functions of the body including breathing, digestion, heart function etc. This nerve surgically controls the motor function of the muscles that helps in pushing the food from the throat to the stomach.

Peristalsis

Peristalsis is the movement of food from the throat to the stomach. This is achieved through well orchestrated muscle movement in the esophagus which is coordinated with the help of the vagus nerve. Swallowing food causes patterned activation of neurons in the vagus nerve which triggers specific neurons that results in the dual action of contraction and relaxation in the esophagus.

  1. Contraction of muscle above the food – These neurons uses Acetylcholine to stimulate the contraction.
  2. Relaxation of the muscle below the food – These neurons use Nitric oxide to stimulate relaxation.

This coordinated contraction and relaxation of the esophageal muscles pushes the food from the throat to the stomach.

I believe that the greatest gift you can give your family and the world is a healthy you.
– Joyce Meyer

What is an Esophageal Spasm?

This disturbing and painful condition affects approximately 1 out of 100,000 people in the US 1 and statistics show that women are more likely to suffer from esophageal spasm than men. 2 Also, it is seen that aging has direct correlation to spasms. i.e. incidence of spasms increase with age. Esophageal spasm is a disorder of the rhythmic and coordinated propulsive contractions of the esophagus. During a spasm, these propulsive contractions (that helps food reach the stomach) are replaced by excessive muscular contractions that restricts the movement of food through the esophagus. Occurrence of spasm is not limited to the time when you are eating, it can happen at random occasions too. (Even while you are sleeping or walking!)

Can you die from esophageal spasm?

Esophageal spasm is not life threatening. However, it can be painful and incapacitating. You can probably cure it through remedies, proper diet and lifestyle changes.

Do esophageal spasm go away?

A minimum 6 second duration is required to be clinically classified as an esophageal spasm. Typically esophageal spasms can last for a couple of minutes to even hours depending on the type of esophageal spasm.

What are the types of Esophageal Spasms?

There are three types of esophageal spasms 3

  • Diffuse esophageal spasms: In this type of esophageal spasm, the contractions are of normal amplitude but it is not coordinated and may occur simultaneously in different parts of the esophagus.
  • Hypertensive peristalsis/Nutcracker esophagus: In this type, the contractions are coordinated but the amplitude is excessive.
  • Hypercontractile esophagus/Jackhammer esophagus: This is an amplified version of  Nutcracker esophagus where the amplitude of contractions are very high and the spasm involves most of the muscles in the esophagus. This type of spasm last for a prolonged period of time.

What causes Esophageal Spasms?

The cause of esophageal spasms are still not fully understood. However, below theories are the ones that are in the limelight now and further research is underway to fully understand the causes.

  1. Vagus nerve damage: It has been demonstrated that micro-vascular compression of the vagus nerve in the brain stem could be one reason for the spasms.4
  2. Abnormal peristalsis: It is thought that increased release of acetlycholine (that disrupts and amplifies the contraction process in peristalsis) seems to be another factor that triggers spasms. However, the trigger for this is not known.
  3. Gastroesophageal reflux disease (GERD): GERD causes gastric acids to surge into the esophagus. The highly acidic nature of the stomach acids irritates the esophagus and prolonged exposure is thought to damage the nerves and muscles in the esophagus that may result in spasms.
  4. Anxiety/Depression/Stress: Stress affects every part of the body including esophagus. Anxiety is thought to aggravate acid reflux, GERD symptoms due to the fact that it triggers the ‘fight or flight’ response which stops digestion, increases stomach acid production, affects contraction of the digestive muscles (resulting in spasms) and even cause inflammations.5

What do an Esophageal Spasm feel like? What are the symptoms?

An onset of Esophageal spasm may have the following symptoms

  • Pain in jaw that radiates to the chest area.
  • Sharp pain in chest.
  • Fluttering feel in the throat.
  • Sensations like popping bubbles in throat.
  • Tightness in the throat.
  • Unable to swallow food or liquids.
  • Heart rate increases.
  • Feeling like something is stuck in the throat.
  • Breathing trouble.
  • Panic attack.
  • Fainting.
  • Regurgitation.
  • Heartburn.

Read more in our audience poll. Please consider sharing your experience in the poll too. Remember, sharing is caring!

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How to diagnose esophageal spasms?

Barium X-Ray/Barium Swallow: In this procedure, the patient will be asked to swallow a contrast liquid (chalky colored liquid that contains Barium) and images are taken of the esophagus using X-Ray.

Endoscopy: In this procedure, a flexible tube is inserted through the throat to see the insides of the esophagus.

Esophageal manometry: Muscle contractions are measured in the esophagus when water is swallowed. This is the most effective method to diagnose esophageal spasms.

Esophageal pH monitoring: This test helps to identify if  the gastric juices are irritating the esophagus.

What are the treatment options available for esophageal spasms?

Avoid the triggers: If spasms occur rarely, it is suggested to identify the foods that triggers spasm and try to avoid it.

Treat the underlying conditions: For e.g. GERD, heartburn are closely related to esophageal spasm and it is suggested to treat these conditions first. Once these are resolved, spasms will eventually disappear.

Medication to calm the muscles in esophagus: Nitrates, Hydralazine, Botox injections, Calcium channel blockers help to reduce the severity of the spasms by relaxing the smooth muscles in the esophagus. Note that all these drugs have undesired side effects.

Surgery (myotomy): Myotomy is a surgical procedure which cuts off a small portion of the muscle at the lower esophagus. This is done to weaken the esophageal contractions. It is the least preferred option as we are not fully aware of its side effects.

Peroral endoscopic myotomy (POEM): This is same as Myotomy but a less invasive technique as the procedure is done via an endoscope through the mouth.

Surgery and POEM should be the last options and if possible, should be avoided. These surgical options try to resolve only the symptoms and do not try to fix the underlying cause. Even if it fixes the spasms, new GI complications could come up later on due to the fact that the GI system is still in havoc. We would urge everyone to first try and repair your GI system using the guidelines mentioned in the diet section. These may help you cure the underlying problems and make your spasms disappear. If however, even after 3 months of proper food habits, if you still have spasms, we leave it to your and your doctors judgement whether to go for the surgical options.

What happens to the esophagus over time?

If esophageal spasms are left untreated for a long period of time, strictures may develop in the esophagus. Strictures are narrowed regions in the esophagus which makes swallowing much more difficult. If this happens, Esophageal Dilation procedure needs to be done to stretch the Esophagus.

Triggers for Esophageal Spasms

Below triggers are seen to cause spasms in individuals. Note that every person is different and the triggers for you may be different. Use the below data as a reference to help you identify the triggers in your case. Keep a journal to note down the foods you eat on a daily basis and this can help you isolate the food that triggers the spasm.

  • Consuming very hot or cold foods.
  • Alcohol, Smoking
  • Coffee, Cola and other carbonated beverages,
  • Garlic, Onions, Citrus fruits
  • Chocolate, Fried and Fatty foods, Bread/Rolls, tomato sauce
  • Chicken

To read about more triggers experienced by our readers, use the audience poll tab. While you are at it, please use the poll to share your experience on the triggers that cause spasms for you. This may help others find their trigger much faster and improve their quality of life. Sharing is caring!

What are your triggers for esophageal spasms?
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Risk factors that may be connected to Esophageal Spasms

It is seen that people that suffer episodes of esophageal spasms usually belong to the below category or have these conditions

  • Being a woman (Unfortunately, women are more prone to esophageal spasms)
  • Being older (60 to 80 is the common age for esophageal spasms)
  • High blood pressure
  • Severe heartburn
  • GERD (Gastro Esophageal Reflux Disease)
  • Achalasia
  • Acid reflux
  • High stress levels
  • Psychiatric disorders
  • Anxiety or Depression

If you have one or more of these risk factors, you may be more susceptible to experience esophageal spasms.

Supplements that ease esophageal spasms

Caution: Always consult your doctor before starting on supplements as the right amount to supplement varies for each person and it may cause interactions with any other medications you are already taking.

Magnesium

Magnesium is a very important mineral for the well being of our muscles and its deficiency can lead to spasms. There are many cases where esophageal spasms have been successfully cured by just supplementing Magnesium. Consult with your doctor on testing your Magnesium levels before starting on supplements.  It is best to take magnesium supplements at bedtime. Spinach, Chard, Pumpkin seeds, Yogurt, Almonds, Black beans, Avocado, figs etc. are high in magnesium. Try to include them in your diet.

Potassium

Muscles need potassium to function properly. Deficiency leads to muscle spasms and weaknesses. Apple Cider Vinegar, Tomatoes, Bananas, Avocado, Broccoli, Sweet Potato, Salmon, Peas, Sardines have high concentrations of potassium, so include them in your diet to increase your potassium levels.

Melatonin

Melatonin is a naturally occurring hormone that is intrinsically made in various parts of the body. Studies have shown it is effective in treating GERD symptoms which is considered as a probable cause for spasms. Some of the Melatonin boosting foods are Pineapples, Banana, Oranges, Oats, Sweetcorn, Barley, Asparagus, Pomegranate, Olives, Grapes, Cucumber, Walnut, Peanuts etc.

Esophageal spasm and essential oils

peppermint-essential-oil-sore-throatEssential oils are well known for their health benefits. There are couple of them that alleviates the symptoms related to esophageal spasm too. Some of them actually possess antispasmodic properties that helps in relaxing the muscles.

Lavender essential oil is known to be beneficial in bringing down the intensity of the esophageal spasm and to control the contractions in the esophagus that is responsible for the spasm in the first place. Lavender oil is considered to be an antispasmodic, anti-inflammatory, anti-septic and an anti-depressant as well.

Peppermint essential oil is famously used for treating various digestive disorders and even muscle pains. Recent scientific studies have shown that ingestion of peppermint oil during an esophageal spasm lowered the intensity and duration of esophageal spasm.

Note that essential oils are by nature not meant to be ingested orally without the advise from a qualified aromatherapist. If you decide to take it on your own hands, at least make sure you don’t ingest more than a drop of it during a day as essential oils are highly concentrated.

How to stop esophageal spasms naturally? 17 Natural remedies

Below are natural remedies that help alleviate the pain and suffering of spasms and may even help in reducing the underlying cause of spasms.

  • Aloe Vera gel: Aloe Vera is good for digestion 6 and also helps to heal the esophagus. A few tablespoons of Aloe Vera gel before a meal can be beneficial in preventing spasms. Aloe Vera is also considered a good remedy against acid reflux, heartburn and GERD.
  • Peppermint oil: Studies 7 have shown that peppermint oil (5 drops in 10 ml water) helps alleviate the pain and duration of spasms. It helps reduce the intensity and irregularity of the contractions in the esophagus during an attack. But note that due to the fact that it relaxes the muscles in the esophagus, it could make GERD symptoms (acid refux, heartburn) worse. So it is advisable to check with your doctor first.
  • Peppermint tea for esophageal spasms: For tea lovers, peppermint tea provides similar benefits as peppermint essential oil. A warm (not hot or iced) peppermint tea 15 minutes before a meal can be beneficial to calm the esophagus muscles and prevent an onset of spasm.
  • Peppermint lozenges: On the go, peppermint oil or tea are not viable options. Lozenges can help in such situation. Have a pack of peppermint lozenges handy so that you can quickly pop one under the tongue when you feel the onset of a spasm.
  • Hot water bag/bottle on the chest area: Although, this does not help stop a spasm, it can be used as a supplemental treatment. Heat relaxes the muscle and can help in lowering the pain.
  • Chamomile tea: Chamomile is one of the most ancient herb known to man and is very effective in relieving muscle spasms, gastrointestinal disorders, dispelling gas, relaxing the muscles. Studies have shown that it is more effective than over the counter drugs to relieve acidity.
  • Crampbark: Crampbark is a very useful herbal aid for spasms. It is a natural muscle relaxant and also de-stresses the entire body.
  • Skullcap Tea: Skullcap is a popular herb which is a good muscle relaxant and is effective in treating muscle disorders.
  • Slippery Elm: Slippery elm is the ‘King’ herb for digestion. It can treat underlying digestive disorders that cause spasms and help you improve your whole digestive system.
  • Valerian Root: Valerian is a beneficial herb that has a sedating and calming effect. It helps in bringing down anxiety and depression which is a trigger for spasms. Also, it helps to relax muscles and effectively reduces pain.
  • Kava root: Kava root is another muscle relaxer that is widely in use today.
  • Lavender essential oil: Lavender essential oil soothes pain and helps in relaxing tension in muscles. It also uplifts overall mood of the person and alleviate anger/stress.
  • Cayenne pepper: Some people have seen consistent results by using Cayenne pepper as a remedy for Spasms. It is a natural muscle relaxer and ‘Capsaicin’ in Cayenne pepper prevents the activation of neurotransmitters that causes pain sensation.
  • Passion flower: It is a herb relaxer and produces calming effect on the body. It also induces sleep and studies have shown that it helps alleviate muscle tension and is an effective stress reducer.
  • Licorice: It has been used as an old folk remedy around the world for various ailments ranging from cold to liver problems. It is especially useful for treatment of GI disorders. Take Deglycyrrhizinated licorice (2 tablets or 1/2 tsp powder) before meals and at bed time.
  • Apple cider vinegar with mother: ACV has been used by millions for its beneficial effects in the human body. It is especially seen to reduce acid reflux symptoms. Mix 1 tsp ACV with a glass of water and drink it 5-10 minutes before each meal. It will help increase the acidity level in your stomach and therefore, food can be easily digested.
  • Supplements: As discussed earlier, deficiency of magnesium and potassium can lead to spasms. Make sure your levels are checked and supplemented if required.

 What are the lifestyle changes that may help alleviate the symptoms?

  • Identify triggers: Keep a log of foods and beverages consumed throughout the day. This will help isolate the foods that triggers spasm.
  • Modify food habits
    • Avoid caffeine.
    • Avoid alcohol as much as possible. If unavoidable, drink it along with meals.
    • Reduce intake of fatty and spicy foods.
    • Reduce sugar consumption.
    • Have early dinner.
    • Avoid hot or cold food and beverages.
    • Have 4-6 smaller meals instead of large meals.
    • Eat slow, chew the food well.
  • Elevate bed: By slightly elevating the bed, we can utilize gravity to prevent the gastric acids from getting into the esophagus.
  • Exercise: A healthy weight is essential for proper functioning of your body. However, make sure you do not exercise right after a meal.
  • Quit smoking: Nicotine relaxes the lower esophageal sphincter and causes the acid to come up to the esophagus.
  • Wear loose and comfortable clothing
  • Get overall health under control

Summary

Esophageal spasms are extremely painful disorder that can incapacitate the patient. In most of the cases, it is seen that the underlying cause is GI disorders like GERD, acid reflux etc. Although there are ways to treat the symptoms and alleviate the pain, it is advised to gradually make the mentioned lifestyle changes and repair your digestive function altogether.

References


  1. Paterson W, Goyal R, Habib F. Esophageal motility disorders. Nature.com. 2017. Accessed November 15, 2017.

  2. Diseases & Conditions – Medscape Reference. Emedicine.medscapecom. 2017. Accessed November 15, 2017.

  3. Roman S, Tutuian R. Esophageal hypertensive peristaltic disorders. Neurogastroenterology & Motility. 2012;24:32-39. doi:10.1111/j.1365-2982.2011.01837.x.

  4. Patent US8992941 – Method for treatment of esophageal spasm. Google Books. 2017. Accessed November 15, 2017.

  5. Song E, Jung H, Jung J. The Association Between Reflux Esophagitis and Psychosocial Stress. Digestive Diseases and Sciences. 2012;58(2):471-477. doi:10.1007/s10620-012-2377-z.

  6. Radha M, Laxmipriya N. Evaluation of biological properties and clinical effectiveness of Aloe vera: A systematic review. Journal of Traditional and Complementary Medicine. 2015;5(1):21-26. doi:10.1016/j.jtcme.2014.10.006.

  7. Pimentel M. Peppermint oil improves the manometric findings in diffuse esophageal spasm.PubMed – NCBI. 2017. Accessed November 15, 2017.

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Hello! This amazing article was posted by one of the wonderful writers at Naturazi! They strive exceptionally hard to provide you with the relevant knowledge, tips and resources to live healthy and heal naturally.

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