Motility disorders like esophageal spasms, or achalasia, can be quite unpleasant. Spasms occur when the lower esophageal sphincter does not relax and allow food to pass into the stomach. Symptoms include difficulty swallowing solids and liquids, regurgitation, bloating, nausea, retching, vomiting and chest pain. This problem can occur at any age, but typically affects middle-aged to older adults. It can be inherited, the result of a parasitic infection, associated to acid reflux problems, or in some cases cancer. Although the condition may not be preventable, complications and discomfort can be minimised by various treatments.
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Treat underlying conditions like heartburn or gastro-oseophageal reflux disease. Psychological distress such as anxiety or depression can also trigger spasms. Regular exercise is often beneficial for managing stress, anxiety and depression. Other things like relaxation techniques, meditation, breathing exercises and joining a support group can be helpful for reducing various symptoms, including spasms. In some cases additional therapy and antidepressant medication may be necessary.
Make appropriate modifications to diet and lifestyle habits. Particular foods, like chocolate, peppermint, alcohol, spicy, fatty or acidic foods, and caffeinated beverages, are known to promote acid reflux and should be avoided. Smoking should also be avoided, as well as eating too close to bedtime. Sleeping in an elevated position or sleeping on the left side, rather than the right, can help minimise reflux and spasms.
Consult your doctor about possible medications. Such things as antacids, histamine antagonists, and foam barriers are available to neutralise stomach acids. Proton pump inhibitors are designed to block secretion of acid and can work for a longer period of time. These inhibitors are also beneficial for protecting the oesophagus, allowing time for inflammation to heal. Pro-motility drugs are also available which increase pressure in the lower esophageal sphincter and stimulate muscles of the digestive tract, reducing reflux and spasms. Also, antidepressants can be prescribed which reduce anxiety and help with pain.
Consider endoscopic treatments. Several treatments have been developed and tested witch essentially tighten the sphincter and reduce spasms and reflux. One method involves stitching of the lower esophageal sphincter. Another uses radio-frequency waves applied to the sphincter causing scaring which tightens the surrounding tissue. A third method involves injecting materials into the esophageal wall increasing pressure. The advantage to these methods over surgery is that they can be preformed without hospitalisation. However, the downside is that long-term effectiveness is not yet known as these methods are fairly new.
Talk with your doctor about surgical options. Surgery is generally reserved for rare cases and is a last resort when all other options have failed. One type of surgery is a procedure which makes esophageal contractions weaker by cutting the muscles where spasms occur, called myotomy. There are additional surgical procedures designed to prevent reflux called fundoplication. It is important to consider that even with surgery, many patients will still continue to take medications for symptoms.
Tips and warnings
- Rare or occasional esophageal spasms my not require any treatment. It is important to pay attention to triggers that can induce these episodes, and simply try to avoid them.
- It is important to note that the chest pain associated with esophageal spasm is very painful, and can be quite alarming. Chest pain usually will increase after eating or drinking, and may be felt in neck, arms, and back. Always consult with a physician if you are not certain of the cause of chest pain.
- Complications include breathing food contents into the lungs causing pneumonia, or tearing of the oesophagus.
- Calling your health care provider if you are unable to swallow or it is painful, or if symptoms continue even after treatment.
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