What is diffuse esophageal spasm?

Diffuse esophageal spasm (DES) is an esophageal motility disorder in which the esophagus—the muscular tube responsible for transporting food from the mouth to the stomach—loses the coordinated, continuous contractions needed to move food downward. Instead of this normal, smooth movement, strong and irregular muscle spasms occur in the esophageal wall, leading to a sensation of pain or difficulty swallowing [1].

This condition is mainly characterized by episodes of chest pain, which can be severe and often resembles the pain of a heart attack, causing significant anxiety for the patient. In addition to pain, those affected may experience difficulty swallowing solid foods or liquids, or the sensation that food is stuck in the chest immediately after swallowing [3].

How is esophageal spasm diagnosed?

Because the symptoms of esophageal spasm mimic those of other, more serious conditions, particularly those related to the heart, the first step in diagnosis is to rule out cardiac causes. After ensuring the heart is healthy, doctors use specialized tests to precisely evaluate esophageal motility:

• Esophageal Manometry: Considered the most accurate diagnostic tool, a thin tube is passed through the nose into the esophagus to measure the strength and timing of muscle contractions during swallowing, revealing abnormal spasms [4].
• Upper GI Endoscopy: The doctor uses an endoscope equipped with a camera to directly view the lining of the esophagus to rule out inflammation, masses, or ulcers; it can also be used to take tissue samples (biopsies) when necessary [2].
• Imaging studies (such as a barium swallow): The patient is asked to drink a liquid containing barium while undergoing X-rays, which allows doctors to observe any abnormalities in the movement of food within the esophagus [4].

  Treatment options and symptom management

  There is no one-size-fits-all treatment approach; the treatment plan depends on the frequency and severity of symptoms and their impact on the patient's quality of life. Doctors often focus on reducing the severity of spasms and improving the esophagus's ability to function. Recommendations usually begin with dietary modifications, such as avoiding very hot or very cold foods and drinks, and eating smaller, more frequent meals [4].

  In cases where symptoms are severe, doctors may prescribe medications such as calcium channel blockers or antidepressants to reduce pain, or botulinum toxin (Botox) injections to help relax the esophageal muscles [4]. In rare and persistent cases, surgical intervention or a POEM procedure (per-oral endoscopic myotomy) to cut the spastic muscle may be considered. For more details on these procedures, you can read our dedicated article on Diffuse Esophageal Spasm: Non-Cardiac Chest Pain, Diagnosis, and Treatment (Arabic). It is essential that the treatment plan be subject to careful medical supervision and regular follow-up.

  Signs requiring emergency care

  It must be emphasized that chest pain requires extreme caution; do not assume it is caused by esophageal spasm without a comprehensive medical evaluation. Go to the nearest emergency department immediately if chest pain is accompanied by severe shortness of breath, pain radiating to the jaw, neck, or arm, or if you experience cold sweats or dizziness, as these symptoms may be indicators of a serious cardiac event that requires urgent medical intervention [1].

  Medical references

  • Esophagus Disorders
  • Upper GI Endoscopy - NIDDK
  • Achalasia
  • Esophageal spasms - Diagnosis and treatment - Mayo Clinic