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You're really thirsty and you take a huge gulp of a cold, carbonated beverage. Suddenly, you experience a severe pain in your midchest that lets up after a couple of seconds. This is one form of an esophageal spasm. In some people, esophageal spasms occur with much greater frequency and can lead to chronic swallowing problems and pain.

Your esophagus is a long tube-like structure that connects your throat to your stomach. A healthy esophagus moves food into your stomach through a series of coordinated muscular contractions, called peristalsis. Esophageal spasms disrupt this process.

Esophageal spasms are an uncoordinated series of muscle contractions that prevent food from traveling properly from your esophagus to your stomach. These spasms can be very painful. Chest pain is a common symptom of esophageal spasms.

The cause of esophageal spasms is unknown. Esophageal spasms are more common in people with acid reflux disease, and your likelihood of developing the condition increases with age.

Treatment of esophageal spasms in the short term may involve using medications to quickly relax the esophageal muscles. Long-term treatment may involve managing any contributing health condition, taking additional medications, altering your eating habits, and other approaches.

Esophageal spasms affect the smooth (involuntary) muscles in the walls of your lower esophagus. These spasms may occur in two forms:

• Diffuse spasms. These simultaneous or irregular contractions of esophageal muscles slow down the progress of food toward your stomach.
• Nutcracker esophagus. Food may progress to your stomach normally, but the contractions of your esophageal muscles are painfully strong.

For both forms of esophageal spasms, periods of contractions often occur intermittently, becoming more severe over a period of years.

Signs and symptoms of esophageal spasms include:

• Pain in your chest, often intense, which you might mistake for heart pain (angina)
• Difficulty swallowing (dysphagia)
• Painful swallowing
• The feeling that an object is stuck in your throat (globus)
• Bringing food back up (regurgitation)
• Heartburn, a burning sensation that may radiate from your upper abdomen to your neck, sometimes leaving a sour taste

Esophageal spasms can be difficult to diagnose because of their similarity with other disorders, such as gastroesophageal reflux disease (GERD), a condition in which stomach acid or bile flows back (refluxes) into your esophagus, irritating its lining.

The exact cause of esophageal spasms is unknown. Some possibilities include:

• Extremely hot or extremely cold foods, although how these foods may trigger the spasms is unclear
• Gastroesophageal disease (GERD) or heartburn, conditions affecting the esophagus and which may trigger spasms

Esophageal spasms are more common in women, and the incidence increases with age. If you have gastroesophageal reflux disease, you may be more prone to esophageal spasms. Your doctor may test you for reflux or try a medication targeted at acid reflux.

If you have difficulty swallowing, chest pain, frequent heartburn or difficulty keeping food down, see your doctor.

Your doctor may confirm a diagnosis of esophageal spasms by these methods:

• Barium swallow (esophagram). This is the best imaging study to help diagnose esophageal spasms and a common test for people who have difficulty swallowing. A barium swallow uses a series of X-rays to examine your esophagus. During the test, you'll drink a thick liquid (barium) that temporarily coats the lining of your esophagus so that the lining shows up clearly on X-ray images. You may also have air blown into your esophagus, to help push the barium against the esophagus walls.

  After the test, you can eat normally and resume your daily activities, although you'll need to drink extra water to help flush the barium from your system and prevent constipation.

• Esophageal motility (manometry) test. In this test, your doctor inserts a thin tube through your nose or mouth into your esophagus to measure the effectiveness of your esophageal muscles in the swallowing process.
• Esophageal computerized tomography (CT) scan. CT scans use an X-ray-generating device that rotates around your body and a powerful computer to create cross-sectional images, like slices, of the inside of your body. This test may show abnormal thickening of your esophageal muscles, a possible indicator of esophageal spasms.

Treatment may include:

• Managing any underlying conditions. Conditions such as heartburn or GERD may trigger spasms.
• Behavior modification. Your doctor or a dietitian may suggest approaches ranging from changing your eating habits (for example, avoiding meals before bedtime) to changing your diet (avoiding certain foods, such as spicy or acidic foods).
• Biofeedback. In this method, you use the power of your mind to control your body. A biofeedback therapist connects electrical sensors to your body to help you recognize and control your body's physiological response to stress. This treatment option is available in many physical therapy clinics, medical centers and hospitals.
• Medications. Smooth muscle relaxants, such as calcium channel blockers or nitrates, can reduce the severity of contractions. Your doctor may also prescribe tricyclic antidepressants, such as trazodone and imipramine, to reduce pain. Newer treatments, such as peppermint oil and sildenafil, have shown promise in small studies. In a small number of people, direct injection of botulinum toxin also has shown some benefit.
• Surgery. In rare cases, surgery may be an option to make esophageal contractions weaker (myotomy) or to remove your esophagus entirely (esophagectomy).

Your diet may have a dramatic effect on reducing esophageal spasms. Pay attention to which foods seem to cause the spasms.

Avoiding hot, cold or spicy foods, large meals, or foods with a high acid content (such as fruit juice, chocolate and tomatoes) may decrease the occurrence of spasms.