• Esophageal spasms present with non-cardia chest pain, which is located retrosternally and radiates to the back. Patients also complain of dysphagia which is characterized by difficulty swallowing several seconds after initiating a swallow, a sensation of food getting stuck and regurgitation. There is also a globus sensation, and many patients suffer from heartburn.
• The symptoms are intermittent and vary in frequency and intensity. Pain may be triggered by particular food and drinks.
• In the hypertensive variants, pain is the predominant symptom, with mild dysphagia [8].

• Pain

  The presentation of esophageal motor disorders may not be clear, particularly when the presenting symptom is chest pain. Determining whether the pain is cardiac or digestive in origin is crucial. [ncbi.nlm.nih.gov]

  This pain, often described as a squeezing pain under the breastbone, may accompany exercise or exertion, making it difficult for a doctor to distinguish it from angina (chest pain stemming from heart disease). [merckmanuals.com]

  If chest pain should change location, duration, character (type of pain) or becomes more severe, seek medical advice as soon as possible as this could indicate a new or more serious problem. [capitolgi.com]

• Severe Pain

  Esophageal spasm also may cause severe pain without swallowing difficulty. [merckmanuals.com]

  These contractions move food through the esophagus but can cause severe pain.[4] Signs and symptoms[edit] The symptoms may include trouble swallowing, regurgitation, chest pain,[5] heartburn,[6] globus pharyngis (which is a feeling that something is stuck [en.wikipedia.org]

• Falling

  Bleeding During Period) Menses Problems Menstrual Cramps (Body Pain During Period ) Migrane Minor Burns Mouth Ulcers Mumps Muscle Pain Muscular Pain Musse (Wart) Musse (Wart) Nasal Polypa DNA Nausea Neck And Shoulder Pain Nervous Neuro Fibroma Night Fall [spakshomeopathy.com]

  2.1 secs Gravity Falls (2012) - S02E04 Animation Aah! [getyarn.io]

  Pain Relief Parkinsons Pediatrics & Maternity Physical Therapy Skin Care Winter Products Oxygen Hospital Supplies Shop by Topic Arthritis Pain Relief Assistive Technology Care for Your Feet Carpal Tunnel Syndrome Diet and Nutrition Emergency Supplies Fall [activeforever.com]

  I figure i have done to much so i lay down then i fall asleep and sleep all day up all night with same pain. So its not rest. Its driving me insane. Makes me tired cuz it hurts so bad. I have used pain tape so much it rips my skin off. [myfibroteam.com]

  Zantac, Prilosec, etc After a couple of hours the pain decreased enough last night for me to fall asleep. Only to awake with an awful chest cold. One minute fine the next feeling like less than crap. [sci.rutgers.edu]

• Anemia

  Physical examination Physical examination is usually performed to look for features like anemia, weight loss and malnutrition due to difficulty in swallowing. [news-medical.net]

  […] [email protected] +91-87004 58818 E-38, Budh Vihar, Badarpur,New Delhi – 110044 Login | Sing Up Spaks Homeopathy Refer and earn 10% Home Homoeopathy Acid Reflux Acidity Gastritis Acne & Face Glower Alcohol De-Addiction Alopecia Areatia Anemia [spakshomeopathy.com]

  Possible Complications Complications may include: Bleeding and anemia Dehydration Iron deficiency Malabsorption Malnutrition Weight loss When to Contact a Medical Professional Call your provider if you are having radiation therapy or have had it in the [mclarenhealthplan.org]

  During history, ask about weight loss, fever, anemia, adynamia, syncope, adenomegalies, abdominal masses, nausea, vomiting, diarrhea, obstipation, abdominal distension, belching, pirosis, early satiety, postprandial fullness, anorexia, jaundice, choluria [scielo.br]

  Angina is usually due to obstruction or spasm of the arteries that supply blood to the heart muscle.[1] Other causes include anemia, abnormal heart rhythms and heart failure. [en.wikipedia.org]

• Chills

  Photo Credit Dolly Faibyshev for The New York Times Work Out and Chill? Cool temperature workouts may be the answer for those who want to exercise without becoming a hot mess. [nytimes.com]

  Visceral involvement symptoms, such as nausea, vomiting, diarrhea, obstipation, fever and chills, are rare in such cases, except for the worsening period of painful crises1,5,9. [scielo.br]

• Non-Cardiac Chest Pain

  Diffuse esophageal spasm is an unusual cause of non-cardiac chest pain (2%) or dysphagia (4%). It occurs most commonly in patients >50 years old but can occur at any age. [radiopaedia.org]

  non-cardiac chest pain Internal medicine Chest pain that simulates cardiac nosologies, but is unrelated to cardiovascular disease; 50% of Pts with NCCP have known reflex and may have postprandial or noctural Sx. See Gastroesophageal reflux disease. [medical-dictionary.thefreedictionary.com]

  It can sometimes cause non-cardiac chest pain. The esophagus is the muscular tube that moves food or drink from the throat down into the stomach when you swallow. [dignityhealth.org]

  Theophylline - improved non-cardiac chest pain in one trial, and may relax the oesophageal wall. [patient.info]

• Dysphagia

  Diffuse esophageal spasm typically causes substernal chest pain with nonprogressive dysphagia and odynophagia for both liquids and solids. [ncbi.nlm.nih.gov]

  These observations raise questions about the role of manometry in patients with dysphagia and suspected achalasia. [appliedradiology.com]

  […] spasm Diffuse esophageal spasm (DES) may be present, however, without the appearance of a corkscrew esophagus Usually occurs over the age of 50 Normal esophageal manometry is present, at least intermittently Clinical Findings Chest pain is the hallmark Dysphagia [learningradiology.com]

• Overeating

  Representing uncoordinated tertiary contractions of the esophagus, corkscrew esophagus is associated with diffuse esophageal spasm Diffuse esophageal spasm (DES) may be present, however, without the appearance of a corkscrew esophagus Usually occurs over [learningradiology.com]

  Esophageal spasm is an infrequent complication of beta-adrenergic over-dose. Possible mechanisms of esophageal spasm and its relief with glucagon are discussed. [ncbi.nlm.nih.gov]

  Clinical findings Primary achalasia usually develops in young or middle-aged adults <50 years of age. 9 Achalasia is an insidious disease that progresses slowly over a period of many years. [appliedradiology.com]

  This is a sham-controlled cross-over study of injection of botulinum toxin or saline, in randomized order, in the distal esophagus. [clinicaltrials.gov]

• Regurgitation

  […] esophageal spasm (DES) may be present, however, without the appearance of a corkscrew esophagus Usually occurs over the age of 50 Normal esophageal manometry is present, at least intermittently Clinical Findings Chest pain is the hallmark Dysphagia Heartburn Regurgitation [learningradiology.com]

  The severity of dysphagia, chest pain, regurgitation, and heartburn was scored on a scale of 0 to 3 before and a mean of 24 months (range 8 months to 13 years) after the operation. [ncbi.nlm.nih.gov]

  Nutcracker, or jackhammer, esophageal spasms: These spasms may be more painful than diffuse ones but don’t typically cause regurgitation, despite their severity. [healthline.com]

• Gagging

  The only thing I've found to stop it (never tried the gagging thing) is one drop of essential oils of ginger and peppermint in a cup of water. [ibsgroup.org]

  You are choking, gagging, or vomiting. You have pain when you swallow. You have new or worse chest pain and shortness of breath. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

  As the condition can cause a choking or gagging feeling, the spasms often cause anxiety, especially when they have been diagnosed. A person’s symptoms will also tend to worsen towards the end of the day and if they are under stress. [medicalnewstoday.com]

  He has severe hyperactive gag reflex. He gags on certain foods because of their texture. He has no heartburn. He also has the feeling of something being stuck in his throat and hard to get his breath. [medhelp.org]

• Intermittent Dysphagia

  We present a 43-year-old female with paroxysmal chest and abdominal pain, nausea, salivation, and intermittent dysphagia. Esophageal testing demonstrated diffuse esophageal spasm, but smooth muscle relaxants provided no relief. [ncbi.nlm.nih.gov]

  Full Text A 68-year-old man was evaluated in our clinic for intermittent dysphagia, regurgitation of liquids and solids, and chest pain. Esophagogastroduodenoscopy revealed a slightly dilated esophagus with retained food. [elsevier.es]

  The usual presentation is intermittent dysphagia with occasional chest pain. [emedicine.medscape.com]

• Chest Pain

  The presentation of esophageal motor disorders may not be clear, particularly when the presenting symptom is chest pain. Determining whether the pain is cardiac or digestive in origin is crucial. [ncbi.nlm.nih.gov]

  […] with diffuse esophageal spasm Diffuse esophageal spasm (DES) may be present, however, without the appearance of a corkscrew esophagus Usually occurs over the age of 50 Normal esophageal manometry is present, at least intermittently Clinical Findings Chest [learningradiology.com]

• Heart Disease

  In some cases, it may cause symptoms such as chest pain, similar to heart disease. In many cases, the cause of DES remains unknown. [en.wikipedia.org]

  This pain, often described as a squeezing pain under the breastbone, may accompany exercise or exertion, making it difficult for a doctor to distinguish it from angina (chest pain stemming from heart disease). [merckmanuals.com]

  Diffuse esophageal spasm (DES) is a rare primary motility disorder of unknown cause, that can be found in patients complaining of chest pain and dysphagia and in whom ischemic heart disease and GERD have been excluded. [ncbi.nlm.nih.gov]

• Hypotension

  VAGOVAGAL syncope consists of hypotension and loss of consciousness associated with cardiac slowing or standstill. The afferent impulses originate in the sensory endings of the vagus nerve. [nejm.org]

  In patients with abnormal tracings, 73 were nonspecific esophageal motility disorder (NEMD), 20 were achalasia, 9 were diffuse esophageal spasm (DES), 8 were nutcracker esophagus, 7 were hypotensive low esophageal sphincter (LES), 3 were abnormal provocative [wikigenes.org]

  "Incompetence" of the UES may be due to its hypotension or reflex relaxation. It results in increased esophagopharyngeal reflux that is best detected by dual pH monitoring techniques rather than esophageal motility studies. [nature.com]

• Retrosternal Chest Pain

  Abstract The hypertensive peristaltic (nutcracker) esophagus represents a motility disorder characterized clinically by squeezing retrosternal chest pain and manometrically by high amplitude esophageal peristaltic contractions. [ncbi.nlm.nih.gov]

• Muscle Spasm

  Source: iStock Muscle spasm facts Spasms can affect many different types of muscles in the body, leading to many different symptoms. [medicinenet.com]

  When it does cause symptoms, muscle spasms throughout the esophagus typically are felt as chest pain under the breastbone coinciding with difficulty swallowing (dysphagia) liquids (especially those that are very hot or cold) and solids. [merckmanuals.com]

  Muscle spasm. 2.1 secs Friends (1994) - S01E08 The One Where Nana Dies Twice Okay, it's in spasm. 1.4 secs The Odd Couple (2015) - S01E08 The Unger Games - What happened? - Oh, neck spasm! [getyarn.io]

• Burning Sensation

  Difficulty or inability to swallow food or liquid Pain when swallowing The feeling that food is caught in the center of the chest A burning sensation in the chest (heartburn) [2] [steadyhealth.com]

• Seizure

  Post-traumatic epilepsy (PTE) can create diagnostic confusion when typical epileptic seizures are not manifest. Abdominal symptoms as a manifestation of PTE are rare in this setting. [ncbi.nlm.nih.gov]

  Spasms vary from mild twitches to severe seizures and may be the signs of any number of disorders. bronchial spasm bronchospasm; spasmodic contraction of the muscular coat of the smaller divisions of the bronchi. esophageal spasm occurs mostly in young [medical-dictionary.thefreedictionary.com]

  I always black out and occasionally have seizures because of it. I am a little worried because no one on here has mentioned any black outs or seizures. Any thoughts? I don't have insurance or money so I can't even see a doctor about this. [healthboards.com]

  Carbamazepine (Tegretol), a seizure-control drug, may be useful in some patients. Botulinum toxin type A (Botox) may be injected into a specific muscle to paralyze it and relieve the muscle spasm of dystonia, such as for blepharospasms. [medicinenet.com]

There is no laboratory marker that can aid in the diagnosis of these conditions. Since these patients have dysphagia an endoscopy will be required to rule out structural problems. If the symptoms are suggestive of gastroesophageal reflux, empirical treatment may be started. If there is no relief then, the below tests should be done [8]. 

Imaging

The modality of choice is barium swallow and esophageal manometry. A barium swallow will show esophageal spasm as of multiple contractions that appear at the same time causing a corkscrew like appearance. Manometry is the best modality to diagnose esophageal spasm. The variants have characteristic findings. Nutcracker esophagus is characterized by coordinated contractions in the smooth muscle of the esophagus with an excessive amplitude and/or duration. Diffuse esophageal spasm, will have is ≥20 percent premature contractions on esophageal pressure topography.

• Esophageal Motility Disorder

  Barium passes through the lower esophageal sphincter into the stomach. Esophageal Motility Disorders Treatment & Management. Eric A Gaumnitz, and Abdullah Fayyad. eMedicine [learningradiology.com]

  Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. [ncbi.nlm.nih.gov]

  Tricyclic antidepressants have produced much success in the treatment of many patients with esophageal motility disorders. [emedicine.medscape.com]

• Corkscrew Esophagus

  […] contractions of the esophagus, corkscrew esophagus is associated with diffuse esophageal spasm Diffuse esophageal spasm (DES) may be present, however, without the appearance of a corkscrew esophagus Usually occurs over the age of 50 Normal esophageal [learningradiology.com]

  Fluoroscopy only 60% of barium swallows will be abnormal <5% will show "corkscrew esophagus" or "rosary bead esophagus" where normal peristalsis is interrupted by many tertiary (non-propulsive) contractions occurring in the distal esophagus non-peristaltic [radiopaedia.org]

  Esophagography evidenced a disorder of esophagus motility with diffuse multiple spasm, reminiscent of the 'corkscrew esophagus'. [ncbi.nlm.nih.gov]

  […] spasm, ESOPHAGEAL SPASM DIFFUSE, OS - Esophageal spasm, diffuse esophageal spasm (diagnosis), diffuse esophageal spasm, ES - Oesophageal spasm, Spasm esophageal, Esophageal Spasm, Diffuse [Disease/Finding], dysmotility esophageal, esophageal spasm, corkscrew [fpnotebook.com]

• There is no totally effective treatment for the hypertensive variants. Initially calcium channel blockers such as diltiazem may be used. Another option are tricyclic antidepressants and imipramine, which have been shown to be effective in small randomized studies.
• If the initial therapies are not successful, few treatment options remain, including botulinum toxin or a nitric oxide contributing drugs (e.g. isosorbide) or sildenafil.
• For extreme cases myotomy is done to relive the pain. If all fails then a last resort is esophagectomy [9] [10] [11].

Mortality is rare but the morbidity is significant and will affect the quality of life with possible psychological problems developing, especially if the diagnosis is not made. Patients are frequent visitors to the emergency room and often get discharged once cardiac cases are ruled out, leaving them confused with little relief from their pain. These patients are at increased risk of achalasia [7].

The true etiology of the condition and its variants is unknown. There have been hypothesis of nerve disorders and gastroesophageal reflux being a cause. The cause of hypertensive spasms is also unknown, but neuronal disorders appear to be there.

There is very little data outside the United States of America, where the incidence is believed to be 1 case in every 100,000 population year. Mortality is rare, but the quality of life may be significantly reduced if the condition is not diagnosed or treated well. It is more common in Caucasians and women [3]. Some of these esophageal motility disorders have been associated with psychiatric conditions.

The pathophysiology of the condition and its variants is not completely understood, but it is thought that there is a problem with the innervation of the muscles. Esophageal spasm may occur due to a deficiency of nitric oxide synthesis and degradation. This hypothesis was formed because these spams respond to glycerine trinitrate.
The hypertensive variants are thought to be caused by due to overactivity of excitatory innervation or smooth muscle response to excitatory nerves [4] [5] [6].

The true etiology and pathophysiology are not known and prevention is difficult to implement. The spasms may be triggered by certain food and drinks, these can be avoided to reduce the attacks. Use of pureed food has been shown to reduce the frequency of the spasms.

Esophageal spasms can be classified into two different types, diffuse esophageal spasm, with the second form having hypertensive peristalsis.

• Diffuse esophageal spasms has uncoordinated normal amplitude contractions with rapid propagation.
• Hypertensive peristalsis is better known as the nutcracker esophagus and is characterised by coordinated contractions with a high amplitude and pressure. There is another variant called the jackhammer esophagus that is a more severe variant with longer a prolonged contraction and is more diffuse [2]. 

• Definition: Esophageal spasm is a distressing condition where food pipe which carries food from the mouth to the stomach, called the esophagus has involuntary contraction with uncoordinated movement of substances. There are subsets of this condition, e.g. the nutcracker esophagus where the muscles are coordinated, but they contract and squeeze the food pipe tight, causing symptoms.
• Cause: The cause is not known but research is ongoing to try and find out. It is thought in some cases acid from the stomach coming back up the food pipe could be cause.
• Symptoms: Esophageal spasms present with central chest pain. Patients also complain of difficulty in swallowing and regurgitation of food. There is also a sensation of a lump in the throat, and many patients have heartburn. The symptoms are intermittent and vary in frequency and intensity. Pain may be triggered by certain types of food. In the hypertensive variants, pain is the predominant symptom, with mild difficulty in swallowing.
• Diagnosis: The diagnosis is made by seeing how the food pipe contracts. This can be done by doing a barium swallow (you are made to swallow a contrast medium while X-rays are being taken). The other test is done by placing a small pipe in the food pipe and measuring the pressures along the pipe while you swallow. The doctor may also order an endoscopy to see the food pipe to make sure there I nothing blocking it and no acid is come out backward into the food pipe. 
• Treatment: There are tablets that are used to help treat the condition. If that doesn’t work then injection with botulism toxin (Botox) is used to reduce the spasm. The patients should avoid foods and drinks that cause or worsen the spasms.

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2. Floch M, et al. Esophageal Motility Disorders. In: Netter's Gastroenterology. 2nd ed. Philadelphia, Pa: Saunders; 2010:Chapter 14.
3. Katz PO, Dalton CB, Richter JE, et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients. Ann Intern Med 1987; 106:593.
4. Konturek JW, Gillessen A, Domschke W. Diffuse esophageal spasm: a malfunction that involves nitric oxide? Scand J Gastroenterol 1995; 30:1041.
5. Jung HY, Puckett JL, Bhalla V, et al. Asynchrony between the circular and the longitudinal muscle contraction in patients with nutcracker esophagus. Gastroenterology 2005; 128:1179.
6. Mujica VR, Mudipalli RS, Rao SS. Pathophysiology of chest pain in patients with nutcracker esophagus. Am J Gastroenterol 2001; 96:1371.
7. Khatami SS, Khandwala F, Shay SS, Vaezi MF. Does diffuse esophageal spasm progress to achalasia? A prospective cohort study. Dig Dis Sci 2005; 50:1605.
8. Song CW, Lee SJ, Jeen YT, et al. Inconsistent association of esophageal symptoms, psychometric abnormalities and dysmotility. Am J Gastroenterol 2001; 96:2312.
9. Cattau EL Jr, Castell DO, Johnson DA, et al. Diltiazem therapy for symptoms associated with nutcracker esophagus. Am J Gastroenterol 1991; 86:272.
10. Miller LS, Parkman HP, Schiano TD, Cassidy MJ, Ter RB, Dabezies MA, et al. Treatment of symptomatic nonachalasia esophageal motor disorders with botulinum toxin injection at the lower esophageal sphincter. Dig Dis Sci. Oct 1996;41(10):2025-31
11. Salvador R, Costantini M, Rizzetto C, Zaninotto G. Diffuse esophageal spasm: the surgical approach. Dis Esophagus. Feb 10 2011