Acid Reflux/GERD

Esophageal Spasms: Could GERD Be Responsible?

can gerd cause esophageal spasms

Do you have GERD (gastroesophageal reflux disease)? Do you know anyone who is afflicted with GERD? If you answered yes to either of these questions, chances are good that you have already experienced, or have observed someone who is experiencing, discomforts which stem from the GERD condition.

The Most Common Symptoms

There are probably millions of people worldwide who suffer from GERD symptoms and probably aren’t even aware of what it is.  

Here are the most common symptoms of GERD:

  • Heartburn or acid indigestion
  • Coughing – persistent without any apparent reason, especially after meals
  • Wheezing or asthma
  • Hoarseness or laryngitis, especially in the morning
  • Bitter or sour taste in the mouth
  • Regurgitation of food or fluids
  • Sore throat or the need to clear the throat
  • Dental erosions
  • The “lump in the throat” feeling

Many people experience these symptoms without even being aware that GERD is responsible. Economically, the U.S. alone can account for over $9 billion being spent annually to deal with this increasingly more common health condition. The good news is that it is both treatable and controllable.

But, What About Esophageal Spasms?

Before we can talk about esophageal spasms, we must first bring everyone up to speed on just exactly what GERD is and why it is so uncomfortable to deal with. Let’s ask and answer some questions about this condition to help you understand it better:

What is the esophagus? 

The esophagus is a tube which essentially connects the mouth to the stomach. It is responsible for moving the food you eat into the stomach for its trip through the digestive tract.

What is an esophageal spasm? 

When it is functioning normally, the esophageal muscles contract to move the food you have eaten from the mouth to the stomach. Under normal circumstances, it performs this action by incorporating regular and coordinated rhythmic movements.  

When the esophagus contracts in an irregular, uncoordinated and sometimes powerful manner, it is called an esophageal spasm.  

Are there types of esophageal spasms?

Some medical practitioners may refer to this condition as “diffuse (or distal) esophageal spasm” or DES. There is another type called “nutcracker esophagus” in which the muscular contractions are coordinated but are really too strong and cause some pretty severe pain to the patient.

What happens to the food being swallowed when this happens?  

These spasms have the ability to keep the food from getting to the stomach. If this is the situation, the food gets stuck in the esophagus.

What happens to the esophagus over time?

If these esophageal spasms are frequent, or considered chronic, the patient is not only subjected to the discomforts mentioned above during the spasmodic episodes, but an esophageal stricture can form, which can further complicate the swallowing process.

What is an esophageal stricture?

An esophageal stricture is an accumulation of benign, non-cancerous types of tissue which build up inside the esophageal tube.  

This stricture is caused by ulcers or chronic inflammation and can make swallowing solid foods more difficult, though swallowing liquids are generally not a problem.  

The types of strictures relate to the size of the constriction:

  • simple having a symmetric diameter of more than 12 mm.
  • complex having an asymmetric diameter of less than 12 mm.

What Are the Symptoms of Esophageal Spasms?

If you have the GERD condition, then you have part of the symptom and cause picture already.

Here are some of the known causes of esophageal spasms:

  • Chest pain – this pain may spread outward to the arms, back, neck or jaw and may feel similar to a heart attack
  • Difficulty or being unable to swallow solid food or liquids
  • Pain with swallowing
  • Feeling like you have food stuck in the center of your chest
  • Heartburn – this is a burning feeling in your chest

What Causes Esophageal Spasms and Strictures?

Esophageal spasms are a relatively rare disorder which is noted for its abnormal muscular contractions in the esophagus.

Having said that, let me also say that, although the research is ongoing, medical science has not yet pinned down the actual reason why this muscular abnormality happens.

The general trend of thought is that the nerve activity which controls the muscular contractions isn’t functioning properly.

Some medical practitioners have found that, for some of their patients, consumption of very hot or very cold foods and beverages can trigger an episode.  

Here are some of the things which are felt to also be GERD triggers:

  • Foods:
    • Garlic
    • Onions
    • Coffee
    • Cola
    • Other carbonated beverages
    • Alcohol
    • Chocolate
    • Fried and fatty foods
    • Citrus fruits
    • Peppermint
    • Spearmint
    • Tomato sauces
  • Medications:
    • Alpha blockers (generally used for the prostate)
    • Nitrates (used for angina)
    • Calcium channel blockers (used for angina and high blood pressure)
    • Tricyclics (used for depression)
    • Theophylline (used for asthma)
    • Bisphosphonates (used for osteoporosis)
    • Anti-inflammatories (used for arthritis, pain and fever)
  • Other causes include:
    • Smoking
    • Obesity
    • Overeating
    • Wearing tight clothing around the waist
    • Hiatus hernia (a condition in which a part of the stomach bulges up through the diaphragm muscle into the lower chest area)
    • Pregnancy

How Are Esophageal Spasms and GERD Diagnosed?

When it comes to diagnosing your condition, your medical practitioner will need some information from you on the history of your complaints.

He’ll need to know what foods or liquids most frequently trigger the episodes and symptoms, where it feels like the food is getting stuck, your general overall health conditions and any medications which you are taking for them — this includes prescription as well as over-the-counter medications.

After this history and your medical practitioners examination, there will need to be some testing done to confirm any diagnosis.

Here are some of those tests:

  • Esophagus tests which may include esophageal manometry  – a test using a small tube down the esophagus attached to instruments which measure pressure.
  • Barium swallow which requires swallowing of a barium solution and x-ray imaging to follow its progress.
  • Other tests may be needed to confirm that the chest pain is being caused by GERD (which is the abnormal backflow of stomach acid, food and other digestive juices from the stomach into the esophagus).

What Can Be Done About Esophageal Spasms and GERD?

As I’m sure you can readily see, the two conditions can and do exist together and, controlling one will certainly go a long way toward controlling the other.  

Here are some of the treatments your medical practitioner may recommend:

Dietary changes – your medical practitioner may make some recommendations about food and liquid changes in an attempt to help make your swallowing easier.

Dilation of the esophagus – this procedure requires that a device be inserted into your esophagus to gently and carefully enlarge any narrowed areas of your esophagus. This is a treatment which may need to be repeated.

Surgery – this recommendation is generally for those people having problems involving the lower esophageal muscle.

Medications – if you’re not able to have surgery or the dilation, your medical practitioner may prescribe medications which are designed to relax the muscles in the esophagus – these medications can include:

  • Calcium channel blockers  
  • Nitrates (sublingual nitroglycerin)
  • Hycosamine
  • Anti-anxiety medications like Xanax or anticholinergic (dicyclomine)
  • Botulinum toxin – this involves injections of botulinum toxin into the smooth muscle of the lower esophagus in the hopes of inhibiting the transmission of nerve pulses thereby relaxing them
  • Relaxed breathing training, biofeedback or hypnosis to provide relaxation
  • Warm water – drinking a glass of warm water has been found to relieve some of the symptoms in less severe cases

Complications to GERD

In addition to the discomforts that accompany the gastroesophageal reflux disease (GERD) condition, there are also some things of which you should be concerned if the condition remains untreated or uncontrolled.  

Of the 19+ million people suffering from GERD, most have the heartburn symptoms and many have the throat and lung symptoms.  

There are, however, some who suffer on to develop complications.  Here are some of the complications from which some GERD patients suffer:

Esophagitis – this is inflammation of the esophagus, also called the food pipe – it causes persistent burning pain which make eating and swallowing difficult and painful – if not treated, ulcers of the tube’s lining can form and these can bleed – as episodes of esophagitis are repeated, scarring can occur which can cause strictures (narrowing of the tube)

A very small percentage (2%) of GERD patients are known to suffer from severe esophagus and the percentage of GERD patients who go on to develop Barrett’s Esophagus is even smaller – Barrett’s Esophagus develops when severe inflammation and acid combine to form premalignant changes in the cells in the lining of the esophagus. Approximately 2% to 5% of those having Barrett’s Esophagus will go on to develop cancer.

To prevent the progression of severe esophagitis to Barrett’s Esophagus and onto cancer, one should take medications which suppress acid indefinitely. If Barrett’s Esophagus has developed, regular endoscopies would help to monitor any progression to cancer.

The bottom line to all of this information about esophageal spasms and gastroesophageal reflux disease (GERD) is this:  if you or someone you love suffers from any of these symptoms and is not currently being treated or if their normal symptoms for which they are being treated change, you really need to get medical advice sooner rather than later.  

The sooner the condition is brought under control and kept under control, the better the prognosis for the patient.

Bibliography:

http://www.webmd.com/digestive-disorders/tc/esophageal-spasm-topic-overview#2

http://www.health.harvard.edu/staying-healthy/gerd-heartburn-and-more

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