Esophageal spasm
Background
- Strong spasms of the musculature of the esophagus that can last minutes to hours and mimic the chest pain of angina
Clinical Features
- Squeezing or tightening pain in the chest
- Can have associated dysphagia +/- globus sensation
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Evaluation
- Unclear what causes esophageal spasm. Possibly related to food intolerance. Can be triggered by eating hot or cold drinks/food.
Workup
- Esophageal spasm is a diagnosis of exclusion. Work-up should focus on ruling out more serious etiologies.
- Consider:
Diagnosis
- Diagnosis of exclusion
- Upper gastrointestinal endoscopy with esophageal biopsies obtained to rule out other causes
- Followed by esophageal manometry
Management
- Step-wise approach to therapy is recommended
- Pharmacologic therapy focused on controlling GERD symptoms
- Trial of peppermint oil before meals
- Trial of Calcium channel blockers
- If the above are not successful consideration of Tricyclic antidepressants