An esophageal spasm is an involuntary and often painful contraction in the esophagus, or food pipe. Painful esophageal spasms may disrupt a person’s life, but certain treatments and remedies can help relieve symptoms.

The esophagus is the tube that connects the mouth and stomach. Normally, it uses a series of controlled, coordinated contractions to transport food from the mouth to the stomach.

Certain foods or underlying conditions can sometimes trigger abnormal esophageal spasms. These contractions may last only a few minutes or up to several hours.

In this article, we look at the causes of esophageal spasms and how to relieve symptoms using medication, natural remedies, and dietary changes.

Identifying esophageal spasms

esophageal spasms cause pain in the throat and chest
A person with an esophageal spasm may experience intense pain or tightness in the chest.

Esophageal spasms are a fairly rare condition. They occur mainly in adults over age 60.

There are two main types of esophageal spasms:

  • Nutcracker spasms, which are intensely painful but do no cause regurgitation, which is when stomach acid or other substances come back up into the esophagus.
  • Diffuse esophageal spasms, which are less painful but can cause regurgitation.

A person with an esophageal spasm may experience the following signs and symptoms:

  • an intense pain or tight feeling in the chest, which may be mistaken for heart pain
  • feeling like something is stuck in the throat or chest
  • difficulty swallowing
  • heartburn
  • food or liquid coming back up into the throat

Esophageal spasms can be diagnosed using a special test where a person swallows barium to make the esophagus visible in an X-ray. Doctors may also use manometry, which uses a thin, specialized tube to measure contractions in the esophagus.

Treatment

Treatment options vary depending on how frequently a person has esophageal spasms and how severe their symptoms are.

A doctor may recommend several different approaches for treating esophageal spasms, including:

  • identifying and avoiding trigger foods
  • making lifestyle changes
  • trying natural remedies
  • managing underlying medical conditions
  • taking medication
  • surgery

We discuss these treatment options below.

Identifying and avoid trigger foods

Some people with esophageal spasms can identify the foods and drinks that trigger their symptoms. Once they know which foods cause spasms, they can avoid them in the future.

Keeping a food diary can be helpful to learn which foods trigger esophageal spasms. People should record the following information in their food diary:

  • the type of food or drink
  • whether it was hot or cold
  • the amount of food eaten in a meal
  • any adverse reactions, such as food allergies

Common food and drink that triggers esophageal spasms include:

  • red wine
  • spicy food
  • food that is very hot or cold

Lifestyle changes

A doctor may recommend certain lifestyle changes for people with esophageal spasms, including:

  • losing weight if a person is overweight or obese
  • avoiding constrictive clothing
  • eating smaller meals more frequently
  • not eating too close to bedtime or before laying down
  • quitting smoking
  • avoiding alcohol, especially red wine

Natural remedies

Some research suggests that using peppermint products may help reduce esophageal spasms.

A review from 2018 suggests that peppermint oil may be effective for treating distal esophageal spasm in some people. Peppermint oil can help relax the muscles, including those in the esophagus.

Mixing a few drops of food-grade peppermint extract into a glass of water and drinking it before a meal may help prevent spasms. It is important to use peppermint extract rather than peppermint essential oil, as the latter can be toxic.

Licorice and menthol products may also have a relaxing effect on the muscles in the esophagus.

Managing underlying conditions

Doctors can prescribe medication and techniques for esophageal spasms
Therapy, stress-management techniques, and antidepressants, can be prescribed for pain caused by esophageal spasms.

In some cases, underlying conditions such as depression, anxiety, or gastroesophageal reflux disease (GERD) can cause esophageal spasms.

A combination of medications, therapy, and stress-management techniques can help a person manage underlying depression or anxiety. A doctor may also prescribe antidepressants for pain caused by esophageal spasms.

Doctors can prescribe proton pump inhibitors or H2 blockers for people with GERD, which may also help reduce esophageal spasms.

Medication

If traditional treatments do not work, a person may be able to try other therapies that help relax the esophageal muscles. These include Botox injections and calcium channel blockers.

Surgery

Surgery for esophageal spasms may be used a last resort if other remedies have not worked. There are two procedures available:

  • Myotomy, in which a surgeon cuts the muscles at the lower end of the esophagus to weaken the spasms. More long-term research needs to be done on the efficacy of this surgery.
  • Peroral endoscopic myotomy (POEM), where a surgeon guides an endoscope with a tiny camera down the person’s throat through their mouth and makes an incision in their esophagus to weaken the spasms.

When to seek medical attention

Any time someone experiences intense pain or a squeezing sensation in the chest, they should seek immediate medical care. While these symptoms can indicate an esophageal spasm, it is crucial rule out other serious medical issues, including heart attacks.

To diagnose esophageal spasms, a doctor will ask a person about their symptoms and do a series of tests, including:

  • an endoscopy to look down the esophagus
  • X-rays using barium
  • esophageal pH tests to see if stomach acid is backing up into the esophagus
  • esophageal manometry, which measures contractions while a person drinks water

Causes

Depression can cause an esophageal spasm
People suffering from anxiety or depression are more at risk of developing esophageal spasms.

While it is not always clear what causes esophageal spasms, some factors may put the nerves in the esophagus at risk of malfunctioning.

These factors include:

  • anxiety and depression
  • gastrointestinal reflux disease (GERD)
  • some foods and drinks
  • certain cancer treatments, including surgery on the neck or radiation on the chest

Risk factors that may increase the likelihood of an esophageal spasm include:

  • a history of GERD
  • consuming very hot or very cold food or beverages
  • drinking red wine
  • having high blood pressure

Outlook

Esophageal spasms are painful but otherwise not harmful. Treatments are available to help a person with esophageal spasms manage and prevent their symptoms.

Avoiding triggers and making lifestyle changes are often the recommended way to treat and prevent esophageal spasms.

It is also essential for someone with this condition to treat any underlying conditions, such as depression, anxiety, or GERD.