The word palpitation (the awareness of the heart beating), a very common symptom in diseases affecting the heart, is adopted when describing a certain disease of the esophagus:”Esophageal spasms”.
This is due to the feeling that people suffering from this disease experience, it is nearly the same as heart palpitations, and usually, the differential diagnosis must be done to distinguish which is the affected organ: the heart or esophagus.
Esophageal spasms or esophageal palpitations as they are also named are sudden painful contractions of esophagi musculature, which is perceived by the patient as palpitation and heartburn, regurgitation and the filling of some object stuck in the esophagi.
They often occur only occasionally and need no treatment, but sometimes they last, and can interfere with the ability to eat and drink. Esophageal palpitations affect mostly people between 60-80 years old.
Some conditions like increased blood pressure, drinking hot liquids, and depression may trigger esophageal palpitations.
Esophageal palpitations (spasms) may be caused by the following conditions:
1. Original esophageal spasms - It is yet unclear what causes esophageal spasms, but in many types of research it appears to because of an abnormal function of the nerves controlling esophageal muscles. There are two types of esophageal spasms:
a. Diffuse esophageal spasms - in this type happen occasional spasms. The contractions of the muscles are irregular, uncoordinated and may be sometimes powerful. They may be painful and are often associated with food or liquid regurgitation.
b. Nutcracker esophagus - Is accompanied with painful and very strong contractions. In this type, the contraction of the muscles is very strong. It is usually not associated with food or liquid regurgitation.
Usually, there is an underlying disease that causes esophageal palpitations (spasms) and not the original esophageal spasms( it is a very rare condition). The most frequent causes are as following:
2. GERD - gastroesophageal reflux disease. It is the return of the content of stomach back in the esophagus. Because stomach has acid content and esophagus has alkaline content, the reflux causes spasms in the attempt to turn the acid content back in the stomach. This is a physiological defense of esophagus, to prevent its mucous from burning.
3. Achalasia- It is a problem with the nerve that controls the muscles in of the lower esophagus and the lower esophageal sphincter. They do not work properly, and often causing muscular spasms.
4. Psychological conditions such as depression and panic attack may cause similar symptoms.
If esophageal palpitations happen only occasionally, avoiding the triggering foods and situations is enough.
But, if they make it difficult eating or drinking, seeking medical advice is a must. The available treatments of esophageal palpitations are as following:
1. Managing the underlying condition
Esophageal palpitations are often
associated with diseases like GERD, achalasia, anxiety or depression. Treating
these conditions will treat also the esophageal problem. Proton pump inhibitor
drugs like omeprazole, lansoprazole are the most effective ways of treating
GERD. To treat depression or anxiety, your doctor might prescribe you
2. Drugs to relax esophageal muscles
The severity of the spasm might be
reduced by using drugs like calcium channel blockers (diltiazem ), on botulinum
toxin A, Sildenafil etc.
3. Surgery (myotomy)
It is indicated only if other treatments fail. It
consists in cutting the muscles at the lower end of esophagi to weaken the
4. Preoral endoscopic myotomy(POEM)
This is a minimally invasive procedure that consists in cutting the muscles in the lower end of the esophagi by means of an endoscope inserted through the mouth into the esophagi.
5. Some lifestyle changes also help in weakening esophageal palpitations. These changes are as following:
1. Avoid your triggers - do not consume products that cause esophageal spasms
2. Do not eat hot food or drink hot beverages- hot foods or drinks can cause esophageal spasms
3. Find a way to control stress- stress may worsen esophageal spasms.
4. Use peppermint lozenge oil- peppermint lozenge is a muscle relaxant and it can help in relaxing esophageal spasms.