oesophageal spasm

Last reviewed 01/2018

Oesophageal spasm is a relatively uncommon condition.

Oesophageal spasm usually affects the elderly and is associated with muscular hypertrophy of the lower oesophagus. It may present with a chest pain that may mimic angina.

On barium swallow there is abnormal peristalsis - corkscrew oesophagus - with uncoordinated contractions.

It is managed conservatively:

• avoidance of precipitating factors, e.g. hot or cold food
• muscle relaxants may be effective, e.g. isosorbide mononitrate and nifedipine
• proton pump inhibitors: may be needed if there is associated reflux

Surgical options include:

• endoscopic balloon dilatation of the gastro-oesophageal sphincter
• oesophagomyotomy: rarely used
• laparoscopic Heller myotomy is thought to be the surgical treatment of choice for diffuse oesophageal spasm
• oesophagectomy: very rarely used if symptoms are intractable

Prognosis

• mortality rate is virtually nil, but there can be much morbidity
• chest pain and dysphagia can lead to an inability to eat and subsequent malnutrition

Notes:

• the term "nutcracker oesophagus" is used to describe when the oesophageal contractions are coordinated but with an excessive amplitude
  • food can usually pass down the oesophagus but pain is a common feature