Diffuse esophageal spasm or nutcracker esophagus or for that matter any esophageal spastic disorders occur dues to abnormality in the innervation of neurons in the esophagus and most of the time the cause is unknown or idiopathic.
Signs & Symptoms of Diffuse esophageal spasm or nutcracker esophagus
- Patients usually have intermittent crushing chest pain, which closely resembles myocardial infarction though the ECG is normal. The chest pain has no relationship with exertion
- Difficulty in swallowing, although their is difficulty in swallowing foods and chest pain, the pain has no relation ship with eating. Difficulty in swallowing is not associated with pain while swallowing thus ruling out odynophagia as well.
The pain in diffuse esophageal spasm or the nutcracker esophagus can be precipitated by drinking or eating cold foods.
Diagnosis of diffuse esophageal spasm
Esophageal Manomentry: Is the single best test to diagnose spastic disorders of esophagus. Manometry reveals high intensity disorganized contractions, these disorganized contractions are unable to propel the food forward causing difficulty in swallowing
Baruim Studies: At the time of the spasm barium studies might show a “corkscrew” like pattern
Treatment of diffuse esophageal spasm
Treatment of diffuse esophageal spasm depends upon the frequency of episodes and intensity of each episode. If the occurrence is not very frequent only reassurance is required. Otherwise, calcium channel blockers like nifedipine and nitrates causes relaxation of smooth muscle thus relieving the symptoms of diffuse esophageal spasm or nutcracker esophagus.