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Re: Esophageal spasm?
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Re: Esophageal spasm?

Posted By HFHSM.D.-rf on June 03, 1998 at 21:30:12:

In Reply to: Esophageal spasm? posted by Octavio on May 28, 1998 at 18:14:09:

My 35 year old sister has been diagnosed with esophageal spasms in the past year. Her problems appeared after a bout of strep throat, followed by a strange "flu" she caught from her husband, who had just returned from southeast Asia. After this "flu", she had difficulty swallowing solid foods for about 5 months. She stated that every time she tried to eat something solid, it would "feel stuck in her throat" and the feeling of something "stuck" persisted for several hours afterwards. This would not happen with liquids, only with solids. Sometimes, he would also be totally unable to swallow, and would choke on her food. During this 5 month period, she lost 30 lbs. Slowly, the difficulty swallowing subsided and now she has no trouble with it at all. Now, once in a while, she complains that she feels like someone has" kicked her in the chest" and she feels very lightheaded, ready to pass out, but it goes by in a few seconds and she is completly well after that. Lately, she has developed chest pains which radiate to both the inside of her arms and to her jaw. During this ordeal she had extensive medical tests, including a normal barium swallow, a normal thallium stress test, several normal 12 lead EKGs, a complete and normal ENT examination and an upper endoscopy. The doctor who performed the endoscopy diagnosed her with "esophageal spasms". She was given a trial of Propulsid but it caused stomach cramping without relief of the other symptoms. Because of continuing episodes of chest pain, she was recently prescribed Prilosec.I have several questions:
1) Are her symptoms indeed typical of esophageal spasms, although her recent pains resemble angina (despite of negative thalium stress test) ? We have no history of heart disease in the family and she is considered extremely low risk by her doctor: pre menopausal, non smoker, non drinker, low cholesterol, normal weight.
2) Can esophageal spasms be diagnosed from an endoscopy, without manometric studies?
3) Are there any viruses that can result in what I have described? As a side note, of the 6 people who "caught" this virus, including my sister and brother-in-law, 3 had "esophageal problems". One resolved spontaneously, my sister is still having problems and one underwent a procedure to rupture a Shatzki ring (which he never had before this"flu"). The ENT specialist who examined her said that her problems swallowing almost sounded like a strange form of Guillan Barre. Is this possible?
4) Can she take the Prilosec safely for extended periods of time?
She is a very energetic and active woman, with no prior health problems, and her symptoms frustrate her and us. I would appreciate your opinion. Thank you.

Dear Octavio,
Esophageal spasm is a condition  in which there are simultaneous (possibly high pressure and long duration ) contractions of the esophageal muscle at several levels.  Nirmally muscle contractions start at the upper esophagus and move down the esophagus towards the stomach.  This regulated contraction forces the swallowed contents down the esophagus and into the stomach.  Patients with esophageal spasm may complain of chest pain ( that can be similar to that of a heart attack) or food sticking in the esophagus (because of the simultaneous contractions)
Although there may be clues on the barium swallow to suggest esophageal spasm, the diagnosis requires mannometry confirmation..  I would arrange for this test to be performed before considering other possible etiologies for the problem.
Prilosec is not an effective treatment for esophageal spasm.  If this medication is helping her, I would question the diagnosis.  The medical treatment for esophageal spasm is smooth muscle relaxants e.g. nitrates, calcium channel antagonists.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet you and to review your history in greater detail. You can arrange an appointment with Dr. Zonca, one of our experts in the diagnosis and treatment of esophageal disorders by calling the Henry Ford Physician Referral Line at (800)653-6568.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
*keywords: esophageal spasm

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