Chest pain, which you may feel while exercising, may be interpreted as a warning sign for heart disease. Instead, it may be a symptom of a problem with the esophagus, particularly an alteration of its motility. This condition is known as diffuse esophageal spasm. We talk about this disorder with Dr. Federica Furfaro, gastroenterologist of Humanitas.
Abnormal contractions
The esophagus is an organ about 25 centimeters long, placed in front of the spine, which connects the pharynx to the stomach, essential for food to continue the digestive process started in the mouth. After swallowing, the food crosses the esophagus to reach the stomach. The esophageal musculature, striated at proximal level and smooth at distal level, consists of an inner layer of circular bundles and an outer layer of longitudinal layers that, through a propulsive contraction (peristalsis) allow the movement of the ingested food along the esophagus. When these contractions are altered and occur unintentionally, we are faced with widespread esophageal spasms. Contractions are usually simultaneous and prolonged, very dynamic. Often the function of the cardias, the lower esophageal sphincter, which is located between the last tract of the esophagus and the stomach and has the function of preventing the rise of the gastric juices from the stomach to the esophagus, is also altered.
The Symptoms
Diffused esophageal spasm is not a very common condition, but more frequent than esophageal achalasia, a more serious pathology always affecting the esophagus. This is characterized by the presence of an increase in the tone of the lower esophageal sphincter and the absence of physiological peristalsis at the level of the esophageal body. Over the years esophageal spasm may evolve in this pathology.
Patients suffering from widespread esophageal spasm complain of retrosternal pain, even at night, associated with dysphagia, i.e. a sensation of difficult swallowing, following the ingestion of food or liquids (especially if very hot or very cold). This chest pain can also occur without dysphagia, for example when the patient is engaged in physical activity and may suggest angina pectoris.
“Also known as an esophageal corkscrew because of the radiological image that is seen after a barium meal, the esophageal spasm has causes that are unknown – explained Dr. Federica Furfaro. This pathology distinguishes a primitive form and a secondary one. In the latter case, the disease is often associated with a gastro-esophageal reflux disease’.
Diagnosis and Treatment
To diagnose this pathology, in addition to the medical examination with an adequate medical history and the evaluation of symptoms, some instrumental tests are necessary. X-ray with contrast medium is useful, but it can often be negative, so manometry is required to observe the pressure and movements of the esophagus and cardias through a small tube inserted into the esophagus. Instrumental examinations are also important to rule out the presence of gastro esophageal reflux disease.
“The treatment of the primitive form is not simple: it involves the use of nitrates and calcium channel blockers, which can reduce the symptoms by favoring the relaxation of the muscles, but which usually have a transitory effect. In some cases, injection of botulinum toxin into the lower esophageal sphincter may be indicated. In the most difficult cases, the patient undergoes surgery to dissect the circular muscle layer and reduce contractions (surgical myotomy). The treatment of the secondary form also involves the use of anti-reflux therapy,” concluded Dr. Furfaro.
