The esophagus is the muscular tube connecting the throat to the stomach, moving food downward through coordinated, wave-like muscle contractions called peristalsis. An esophageal spasm occurs when these muscles contract suddenly and involuntarily, disrupting the normal flow of food and liquids. Because the esophagus runs through the center of the chest, these powerful, uncoordinated contractions often produce a severe sensation of pain. This intense chest discomfort can mimic symptoms of a serious cardiac event, which is why people often seek emergency medical attention.
Describing the Spasm Sensation
The sensation of an esophageal spasm is typically described as an intense, sudden onset of squeezing, tightening, or crushing pain located directly behind the breastbone (substernal pain). This discomfort often radiates outward to the back, neck, jaw, or down the arms. The pain’s severity varies widely, but it is frequently intense enough to wake a person from sleep or cause them to seek immediate medical care.
Many people also experience difficulty swallowing (dysphagia), particularly with both solids and liquids during an episode. This creates the sensation that food or an object is stuck in the throat or chest. Spasm episodes are intermittent, lasting from a few seconds to several minutes or even hours.
Why Esophageal Muscles Contract
Esophageal spasms are classified as motility disorders, meaning they involve a problem with the movement of the esophageal muscles. The underlying cause is generally related to a miscommunication or abnormal functioning of the nerves that control swallowing.
There are two main types of contractions that cause symptoms: Diffuse Esophageal Spasm (DES) and Nutcracker Esophagus (hypercontractile esophagus). DES involves uncoordinated contractions that often lead to regurgitation. Nutcracker Esophagus is characterized by contractions that are too strong and forceful. Several factors are known to trigger these episodes, including consuming very hot or very cold liquids and foods, which can irritate the muscle tissue. Acid reflux (Gastroesophageal Reflux Disease or GERD) and stress or anxiety are also common precipitants.
Distinguishing Spasms from Urgent Pain
It is necessary to distinguish an esophageal spasm from a heart attack, as the symptoms can be nearly identical. The sensation of squeezing, tightness, and pain radiating to the arm or back are symptoms shared by both conditions. Any new, severe, or unexplained chest pain warrants immediate medical evaluation to rule out a cardiac event first.
Cardiac pain, or angina, is often related to physical exertion and typically resolves with rest, which is not usually the case with spasms. Spasm pain is more likely to be triggered by eating, drinking, or stress, and it may not be relieved by rest. Symptoms that should prompt an immediate call to emergency services include chest pain accompanied by:
- Shortness of breath
- Cold sweats
- Dizziness
- Pain that persists without relief
Only after cardiac causes have been excluded can the pain be attributed to the esophagus.
Immediate Relief and Long-Term Management
For immediate relief during a spasm episode, slowly sipping warm water can help relax the esophageal muscles. Peppermint oil, administered via a lozenge or a few drops in water, is a natural smooth-muscle relaxant that can sometimes ease a sudden spasm. Over-the-counter antacids or prescription proton pump inhibitors (PPIs) may also provide relief if the spasm is triggered by acid reflux.
Long-term management focuses on identifying and avoiding specific triggers, such as extremely hot or cold beverages and foods. Since GERD is a common contributor, treating reflux with medication is part of the treatment plan. For more frequent or severe cases, a physician may prescribe muscle relaxants like calcium channel blockers or nitrates, which reduce the intensity of the muscle contractions. Low-dose tricyclic antidepressants are sometimes used for their ability to affect pain perception in the esophagus.