What are the medical care options for esophageal spasm?

Updated: Aug 07, 2019
  • Author: Ahmad Malas, MD; Chief Editor: BS Anand, MD  more...
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Sildenafil, a phosphodiesterase inhibitor, is a smooth muscle relaxant that can lower the LES pressure and spastic contractions of the esophagus in nutcracker esophagus.

Botulinum toxin binds receptors in the nerve endings, thereby decreasing the release of acetylcholine. By endoscopically injecting botulinum toxin above the LES, symptoms may improve. [22] The effect is temporary, and the response decreases with repeated injections.

Balloon dilatation is commonly used for achalasia, but it has been also used to treat diffuse esophageal spasm and nutcracker esophagus. [23] The studies are small, the relief is not uniform, and symptoms recur. Dilation with mercury-filled bougies has been used in the past. [24]

Proton pump inhibitors effectively reduce or alleviate the symptoms of gastroesophageal reflux disease, which may mimic diffuse esophageal spasm. [25] A trial of acid-lowering therapy may be undertaken prior to instituting other treatments. Although treatment is often ineffective, the symptoms from diffuse esophageal spasm and nutcracker esophagus usually improve over time.

Tricyclic antidepressants have produced much success in the treatment of many patients with esophageal motility disorders. Some of these patients may have associated psychiatric illnesses, and concomitant treatment of those conditions may improve outcomes.

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