- Features:
- smooth mm undergoing multiple spontaneous non-peristaltic contractions
- Dysfunction of inhibitory nerves due to patchy neural degeneration of nerve processes
- Clinically:
- Chest pain 🡪 at rest or with swallowing/emotional stress; retrosternal; radiates to back/chest/arms/jaw ,lasts sec-min; mimics MI pain
- Very hot or cold liquids may aggravate the pain
- Dysphagia 🡪 solids and liquids
- Investigations:
- Coronary ischemia ruled out
- Barium swallow: “Corkscrew oesophagus”
- Manometry: cold swallow gives pain, solids/drugs give pain AND SPASM
- Esophageal scintigraphy and provocative tests
- Treatment:
- Esophageal spasms are often difficult to treat, and controlled studies of treatment methods are lacking.
- Anticholinergics, tricyclic antidepressants, nitroglycerin, and long-acting nitrates have had limited
- success.
- Calcium channel blockers given orally (eg, verapamil 80 mg 3 times a day, nifedipine 10 mg 3 times a day) may be useful.
- Botulinum toxin injection
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