Medicines for Oesophageal spasm

What it is

Oesophageal spasm is a condition in which the muscle of the food pipe (oesophagus) contracts abnormally — either with excessive, uncoordinated contractions, or with very forceful ("high-pressure") contractions. Normally, the oesophagus squeezes in a smooth, coordinated wave to move food down to the stomach; in oesophageal spasm, this pattern is disrupted. The main symptoms are chest pain (which can be sudden, severe, and cramping or squeezing, sometimes felt behind the breastbone, and can be mistaken for heart pain), and difficulty or discomfort swallowing (dysphagia), which may come and go and can affect both solids and liquids; sometimes food feels like it sticks, and symptoms can be triggered by eating or drinking (particularly very hot or cold things) or occur spontaneously. Because the chest pain can closely resemble the pain of a heart problem (angina or a heart attack), an important first step is that heart causes are excluded — often oesophageal spasm is only considered after the heart has been checked. Oesophageal spasm itself is usually not dangerous, but it can be uncomfortable and distressing, and its symptoms overlap with other conditions (such as acid reflux and, importantly, a swallowing condition called achalasia), so it is assessed to confirm the diagnosis and exclude these.

How it is treated

The first priority, particularly with chest pain, is to exclude a heart cause, as the pain can mimic heart pain — so cardiac assessment often comes first. Once heart problems are excluded and oesophageal spasm is suspected, the diagnosis is assessed by a gastroenterologist, often with tests such as a camera examination (endoscopy, to look at the oesophagus and exclude other causes), and specialised tests of how the oesophagus muscle works and how it handles swallowing (oesophageal manometry), which can show the abnormal contractions and distinguish spasm from related conditions like achalasia. Treatment aims to relieve the symptoms and reduce the abnormal contractions. Managing any contributing acid reflux is often helpful, as reflux can trigger or worsen symptoms. Medicines that relax the oesophageal muscle (such as certain medicines used to relax smooth muscle) can help reduce the spasms and pain in some people; other approaches, including treatments for the associated pain and, in some, addressing anxiety (as stress can worsen symptoms), are used. Simple measures — such as eating slowly, avoiding trigger foods and very hot or cold items, and managing reflux — help. For severe, resistant cases, specialist treatments (including, occasionally, procedures) are considered. The reassuring message is that oesophageal spasm, though its chest pain can be alarming and must be distinguished from heart pain, is usually not dangerous, and its symptoms can often be managed with treating any reflux, muscle-relaxing medicines, and simple measures.