Oesophageal spasm is a relatively uncommon condition.
Oesophageal spasm usually affects the elderly and is associated with muscular hypertrophy of the lower oesophagus. It may present with a chest pain that may mimic angina.
On barium swallow there is abnormal peristalsis - corkscrew oesophagus - with uncoordinated contractions.
It is managed conservatively:
- avoidance of precipitating factors, e.g. hot or cold food
- muscle relaxants may be effective, e.g. isosorbide mononitrate and nifedipine
- proton pump inhibitors: may be needed if there is associated reflux
Surgical options include:
- endoscopic balloon dilatation of the gastro-oesophageal sphincter
- oesophagomyotomy: rarely used
- laparoscopic Heller myotomy is thought to be the surgical treatment of choice for diffuse oesophageal spasm
- oesophagectomy: very rarely used if symptoms are intractable
Prognosis
- mortality rate is virtually nil, but there can be much morbidity
- chest pain and dysphagia can lead to an inability to eat and subsequent malnutrition
Notes:
- the term "nutcracker oesophagus" is used to describe when the oesophageal contractions are coordinated but with an excessive amplitude
- food can usually pass down the oesophagus but pain is a common feature