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What is esophageal spasm?
2006-02-17 06:45:52
By Dr. Sadikiel N. Kimaro
Esophageal spasms are irregular, uncoordinated, and sometimes powerful contractions of the esophagus, the tube that carries food from the mouth to the stomach.
Normally, contractions of the esophagus are coordinated, moving the food through the esophagus and into the stomach. Esophageal spasms can prevent food from reaching the stomach, leaving it stuck in the esophagus.
Esophageal spasms are rare. Often, symptoms that may suggest an esophageal spasm are the result of another condition such as gastroesophageal reflux disease (GERD) or achalasia, a problem with the nervous system in which the lower esophageal sphincter (LES) doesn’t work properly.
Anxiety or panic attacks can also cause similar symptoms.
What causes esophageal spasm?
The cause of esophageal spasm is unknown. Many doctors believe it results from a disruption of the nerve activity that coordinates the swallowing action of the esophagus. In some people, very hot or very cold foods may trigger an episode.
What are the symptoms?
Most people with this condition have chest pain that may spread outward to the arms, back, neck, or jaw.
This pain can feel similar to a heart attack. If you have chest pain, you should be evaluated by a health professional as soon as possible to rule out or treat cardiac disease.
Other symptoms include difficulty or inability to swallow food or liquid, pain with swallowing, the feeling that food is caught in the centre of the chest, and a burning sensation in the chest (heartburn).
How is esophageal spasm diagnosed?
Your doctor can often determine the cause of esophageal spasm by doing a physical exam and asking you a series of questions.
These include questions about what foods or liquids trigger symptoms, where it feels like food gets stuck, other symptoms or conditions you may have, and whether you are taking medications for them.
The diagnosis can be confirmed with tests, including a barium swallow or endoscopy. These tests use X-rays or a small, lighted viewing instrument to examine the inside of the esophagus.
Your health professional may also do esophagus testing, a set of tests used to evaluate the condition and function of the esophagus.
Tests measure acid levels in the esophagus as well as the strength and pattern of muscle contractions in the esophagus.
Other tests may be done to determine whether chest pain may be caused by gastroesophageal reflux disease (GERD), the abnormal backflow (reflux) of food, stomach acid, and other digestive juices from the stomach into the esophagus.
How is it treated?
Treatment for esophageal spasm includes treating other conditions that may make esophageal spasms worse, such as gastroesophageal reflux disease (GERD).
GERD is usually treated with changes to diet and lifestyle and medications to reduce the amount of acid in the stomach.
Medications such as nitrates and calcium channel blockers may also be given to relax the muscles of the esophagus, though they are not always effective.
Botulinum toxin (Botox) is also being used to treat esophageal spasm. Botulinum toxin is a poison produced by the bacteria that cause botulism. When injected into the esophageal muscles usually during an upper endoscopy it blocks the function of the nerves in those muscles, preventing spasms.
Swallowing peppermint oil mixed with water may make the muscles of the esophagus contract regularly. Treating anxiety with relaxation and controlled breathing exercises may also help to reduce symptoms. 2
Rarely, surgery is used to treat esophageal spasm.
The surgeon cuts the muscles along the lower esophagus. This procedure is usually performed only in serious cases that do not respond to other therapies.
Dehydration occurs when your body loses too much fluid. When you stop drinking water or lose large amounts of fluids through diarrhea, vomiting, sweating, or strenuous exercise, your body’s cells absorb fluid from the blood and other body tissues.
When you are not drinking enough fluids, your muscles begin to get tired and you may have leg cramps or feel faint. By the time you become severely dehydrated, there is no longer enough fluid in the body to get blood to your organs.
You may begin to go into shock, a life-threatening condition.
Dehydration can occur at any age, but it is most dangerous for babies, small children, and older adults.
Dehydration in babies and small children
Babies and small children have an increased risk of dehydration because:
A large proportion of their bodies consists of water.
Children have a high metabolic rate, so their bodies use more water.
A child’s kidneys are not as efficient and do not conserve water as well as an adult’s.
They have an immature immune system, which increases the risk of illnesses that cause vomiting and diarrhea.
Children often will not drink or eat when they are not feeling well.
They depend on their caregivers to provide them with food and fluids.
Dehydration in older adults
Older adults have an increased risk of dehydration because they:
Have a decreased thirst sensation and often don’t feel the urge to drink.
May have kidneys that do not work efficiently.
May have physical problems, such as arthritis, which may interfere with their ability to drink, make it difficult to hold a glass, or painful to get up from a chair.
May have conditions, such as Alzheimer’s disease or a history of stroke, that make it difficult to communicate their needs.
May take medications that increase the risk of dehydration.
May not have enough money to adequately feed themselves.
May intentionally limit fluid intake because they have a problem with incontinence or have a disease that makes going to the bathroom painful or exhausting.
Watch babies, small children, and older adults closely for the early signs of dehydration any time they have illnesses that cause high fever, vomiting, or diarrhea. The early symptoms of dehydration are:
A dry mouth and sticky saliva.
Reduced urine output with dark yellow urine.
Home Treatment
In the early stages, you may be able to correct mild to moderate dehydration with home treatment measures. It is important to control fluid losses and replace lost fluids.
Adults and children age 12 and older
If you become mildly to moderately dehydrated while working outside or exercising:
Stop your activity and rest.
Get out of direct sunlight and lie down in a cool spot, such as in the shade or an air-conditioned area.
Prop up your feet.
Take off any extra clothes.
Drink a rehydration drink, water, juice, or sports drink to replace fluids and minerals. Drink 2 qt (2 L) of cool liquids over the next 2 to 4 hours.
You should drink at least 10 glasses of liquid a day to replace lost fluids.
Rest and take it easy for 24 hours, and continue to drink a lot of fluids.
Although you will probably start feeling better within just a few hours, it may take as long as a day and a half to completely replace the fluid that you lost.
Children ages 1 through 11
Make sure your child is drinking often. Frequent, small amounts work best.
For children with dehydration, an oral rehydration solution (ORS), half-strength orange juice, or plain water (if the child is eating food) may be used to replace lost fluids.
Allow your child to drink as much fluid as he or she wants. Encourage your child to drink extra fluids or suck on Popsicles.
Children between the ages of 4 and 10 should drink at least 6 to 10 glasses of liquids to replace lost fluids.
Cereal mixed with milk or water may also be used to replace lost fluids.
Newborns and babies younger than 1 year of age
Don’t wait until dehydration develops to replace lost fluids. Offer fluids to your baby often.
If you breast-feed your baby, nurse him or her more often.
If you use a bottle to feed your baby, feed him or her more often.
Use an oral rehydration solution (ORS) if mild or moderate dehydration develops.
The amount of ORS your baby needs depends on his or her weight and how dehydrated he or she is. You can give the ORS in a dropper, spoon, or bottle.
If your baby has started eating cereal, you may replace lost fluids with cereal. You also may feed your baby strained bananas, and mashed potatoes if your child has had these foods before.
Symptoms to Watch For During Home Treatment
Use the Check Your Symptoms section to evaluate the symptoms if any of the following occur during home treatment.
More serious dehydration develops.
Decreased alertness develops.
Dizziness, lightheadedness, or feelings of faintness when you rise from lying to sitting, or from sitting to standing develop.
Decreased urination develops.
Symptoms become more severe or frequent.
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