//fpnotebook.com/
Esophageal Spasm
Aka: Esophageal Spasm, Jackhammer Esophagus, Nutcracker Esophagus, Hypercontractile Esophageal Dysmotility, Hypercontractile Esophagus
- See Also
- Esophageal Dysmotility
- Epidemiology
- Rare conditions, even in specialty centers
- Peak age of onset >60 years old
- Pathophysiology
- Loss of inhibitory Neuron innervation
- Peristalsis preserved to some extent but is disordered and incoordinated
- Waves of peristalsis occur simultaneously
- Distal Esophageal Spasm is characterized by premature, forceful contractions
- Jackhammer Esophagus has properly timed contractions, but increased forceful contractions
- Differential Diagnosis
- See Esophageal Dysphagia
- Exclude Achalasia
- Evaluation
- See Esophageal Dysmotility
- Management
- See Esophageal Dysmotility for general measures and overall approach
- General Measures
- Offer reassurance
- Functional disorders and Hypercontractile Esophagus improve or resolve spontaneously in a majority of patients
- Optimize GERD Management
- Antisecretory therapy (e.g. Proton Pump Inhibitor)
- Discontinue Opioids
- Functional Disorders (Hypercontractile Esophagus has significant overlap with functional disorders)
- Stress management
- Consider Cognitive Behavioral Therapy
- Consider Antidepressants
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Tricyclic Antidepressants
- Mindful eating
- Eat smaller, more frequent meals
- Eat slowly
- Choose softer foods
- Avoid foods and situations that trigger symptoms
- Medications
- Precautions
- These medications decrease lower esophageal sphincter pressure and may worsen GERD
- Smooth Muscle relaxants are best limited to hypermotility confirmed by manometry
- Agents
- Calcium Channel Blockers
- Nitrates (Nitroglycerin)
- Phosphodiesterase-5 Inhibitors (release nitric oxide)
- Other agents which are safe and may be effective
- Peppermint Oil (2 mints sublingual before each meal)
- References
- Bennett (2001) BMJ 323:794 [PubMed]
- Wilkinson (2020) Am Fam Physician 102(5):291-6 [PubMed]