An esophageal spasm is a sudden, intense contraction of the muscles lining the esophagus, the muscular tube that moves food from the throat to the stomach. The esophagus works through coordinated, wave-like contractions known as peristalsis. When these contractions become uncoordinated or excessively forceful, the result is an esophageal spasm, a motility disorder that causes significant pain. Understanding this pain is the first step toward managing the disorder and distinguishing it from other serious health concerns.
Describing the Sensation of Esophageal Spasms
The pain from an esophageal spasm is typically felt directly in the center of the chest, specifically behind the breastbone in the retrosternal area. This sensation is often described as a severe pressure, a crushing feeling, or a tight squeezing that can be intense enough to mimic a heart attack. The discomfort frequently radiates outward to the back, neck, jaw, or arms, further adding to the confusion with cardiac pain.
The duration of the pain is highly variable, potentially lasting from a few seconds to several minutes, or even an hour or more. It may resolve spontaneously, but the severity can be debilitating while it lasts. A common accompanying symptom is dysphagia, or difficulty swallowing, which may be felt with both solids and liquids.
Individuals may also experience odynophagia (pain upon swallowing) or the feeling that food or an object is stuck in the throat or chest. In some instances, the uncoordinated nature of the muscle contractions leads to regurgitation, where swallowed food or liquid comes back up the esophagus. These symptoms are often more pronounced in diffuse esophageal spasm (DES), where contractions are uncoordinated, compared to nutcracker esophagus (hypercontractile esophagus), where contractions are coordinated but excessively strong.
Common Triggers and Contributing Factors
The exact cause of esophageal spasms is not fully understood, but the condition is considered a motility disorder related to abnormal nerve signaling that controls the esophageal muscles. Several environmental, dietary, and physiological factors can act as common triggers. One frequently cited trigger involves temperature extremes, as consuming very hot or very cold foods and liquids can provoke a muscle response.
Gastroesophageal Reflux Disease (GERD) is another significant factor, as the backflow of stomach acid can irritate the esophageal lining, which may prompt spasms. Stress and heightened anxiety also play a role, as psychological factors can influence nerve function and muscle contraction within the esophagus. Other dietary triggers may include highly acidic or spicy foods, red wine, and sometimes even swallowing insufficiently chewed food.
How Spasms Differ from Cardiac Chest Pain
The symptoms of an esophageal spasm are frequently mistaken for a heart attack because the esophagus and the heart share sensory nerve pathways, leading to referred pain in the same central area. Certain characteristics can help differentiate the two conditions, although a definitive medical diagnosis is always necessary. Esophageal pain is often closely related to eating or drinking, with spasms frequently occurring during or immediately after swallowing.
A temporary relief after taking antacids may suggest an esophageal cause, particularly if acid reflux is a contributing factor. Conversely, cardiac pain, or angina, is often predictably brought on by physical exertion and may be accompanied by traditional cardiac risk factors like sweating or shortness of breath. Esophageal spasms are typically intermittent and non-exertional, meaning they can occur while at rest.
However, the distinction is not always clear-cut; sublingual nitroglycerin, a medication used for heart pain, can sometimes relieve an esophageal spasm. Furthermore, some individuals with severe coronary artery disease may experience angina after a heavy meal. Because of this potential for misdiagnosis, any new or severe chest pain must be treated as a potential cardiac emergency until a healthcare professional can determine the true source.
When to Seek Medical Care
While esophageal spasms are not life-threatening, their similarity to cardiac symptoms requires immediate urgency for certain signs. Seek emergency medical care immediately if the chest pain is new, severe, worsening, or lasts longer than five minutes. This is especially true if the pain is accompanied by symptoms traditionally associated with a heart attack.
Red flags include pain radiating to the jaw or left arm, shortness of breath, dizziness, cold sweats, or heart palpitations. Additionally, contact a healthcare provider if you experience an inability to swallow liquids or solids (severe dysphagia), or if the pain is accompanied by unexplained weight loss or persistent vomiting. Consulting a doctor is also warranted if symptoms occur frequently, do not resolve, or significantly impair your ability to eat and drink.