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Avatar universal

esophageal spasm?

I have been experiencing what I think is esophageal spasms. Symptoms are excessive spasmodic belching, discomfort in the center to upper chest area, almost like a knot. This becomes most pronounced during periods of stress.  I have been prescribed Prilosec which doesn't seem to relieve my symptoms. However, alprazolam at .5mg eases the feeling and it eventually goes away.  My question is then, is there such a thing as stress-induced spasm of the esophagus?
118 Responses
Avatar universal
Yes, mj, there is esophageal spasm.  This term refers to simultaneous contractions of esophageal muscle at several different levels so that the normal movement of food down the esophagus is impaired.  Symptoms can include chest pain (may simulate a heart attack) and difficulty swallowing solids and liquids (sensation of food sticking in esophagus).  Symptoms can be precipitated by drinking thermally hot or cold liquids e.g. coffee or ice tea.  Stress can also precipitate symptoms.

At present, there are no universally effective treatments.  Smooth muscle relaxants are often used but benefits are unpredictable.
Avatar universal
I have been to this board before with questions and comments about what my docs call "intractable belching."  I empathize with all who have had to deal with this or similar conditions.  Hoping that it will be of some use to others, below I outline what I have done to find a "cure" for this awful disease, whatever it is.

First of all, my symptoms:  there seems to be only one that actually bothers me, and that is the intractable belching. I have been experiencing this for 10 months. On "bad" days, which until recently occurred 3 or 4 days a week, I will belch 150 or more times a day.  There has been no discernable cause for this belching --- and as far as a "pattern", there seems to be none.  They just come when they want to.  On days that are not "bad," I still will belch 40-50 times a day.  The belching comes and goes almost randomly;  I will belch 5-10 times a minute for 3 or 4 minutes, then nothing for 10 minutes, then 5-10 times a minute for 3 or 4 minutes. . . . and then after a while, nothing much for an hour or two.  Then the pattern returns.  The belching causes two very uncomfortable feelings:  (1) the esophogus, which is a muscle, or series of circular muscles, hurts, like any muscle that is over-exerted -- particularly since much of the belching is rather "vigorous";  and (2) the belching creates a feeling of semi-nauseousness.  I have only experienced an acid taste on a few occasions, although endoscopy indicated esophogitis and EMT (?) (esophogael motility test) and 24-hour ph probe indicated an abnormal amount of acid in my esophogus.  Again, however, I do not experience acid reflux like others have reported, and indeed the only surefire way to relieve the belching is to lay flat on my back.

[Before continuing with the chronology of my story -- again, for what it's worth -- let me share with you my understanding (based on what I have to estimate as better than a hundred hours of reading everything I can related to this topic) of the "mechanics" of belching.  I, too, seem to experience (perhaps half of the time) belching that results from esophogael spasms.  My reading suggests that these indeed may be spasms -- or simply the mechanics of a belch:  the esophogus, apparently, will contract when it feels gas/air pushing against the lower esophogael sphincter, as a way of opening the sphincter and releasing the gas/air;  this contraction, I believe, is what seems to be a spasm.  My experience is that the contraction seems to suck air into the esophogus, sometimes sounding like what I call a "pre-belch" belch;  the medical literature refers to this as a yo-yo type of mechanism, and apparantly the sucked-in air never even gets to the stomach, but just belches back up, and perhaps drags along the gas/air that is pushing against the lower sphincter from below.  At the same time, I myself have not dismissed the possibility that there is a neurological component at work here, a spasm;  and I guess I need to learn more about the vagus nerve that others have written about on this board.  A neurologist is the only specialist I have not yet seen for a diagnosis of this condition, but that will happen shortly.]

Before outlining my encounters with the traditional medical specialties regarding this condition, let me mention the alternative therapies I have tried:
          1.  chiropractic
          2.  therapeutic massage
          3.  hypnosis
          4.  biofeedback
          5.  acupuncture
None of the first four of these alternative therapies provided any help (although I would strongly recommend therapeutic massage just 'cause it feels good, and anyone looking for answers and encountering, as many of us have, uncaring and unprofessional physicians deserves this treat.

The jury is still out, so to speak, on acupuncture as far as I'm concerned.  I have made two visits to date.  After the first one, I was belch-free for four full days, which was the first time that had happened since the onset of the intractable belching.  My second visit wasn't as successful, but I am determined to continue with this approach (which really does require one to suspend judgement because, on the surface acupuncture has no immediate visible links to hard science) until it has had enough time to work, if it's going to work.

The tradition medical approaches I have used include:

1.  Family doc/internal medicine --- took some time for him to believe that this was something more serious than an embarassing social problem.  Blood tests revealed the presence of the Heliobacter Pylori antibody, meaning that at some time in my life the little bugger had been in my system.  Doc put me on a 14-day antibiotic regime to do away with the H Pylori, if in fact it was still in me.

2.  Upper GI test concluded there was nothing wrong with my upper GI tract.  

3.  Endoscopy.  Concluded, based on tissue samples, that there was no H Pylori in my esophogus or stomach.  But did make a finding of esophogitis and a hiatal hernia.  My question to several docs has been whether the belching could be related to the hiatal hernia, and their responses have been a resounding "no" --- upwards of 40 percent of adults have hiatal hernia and if they caused belching, they say, there would a lot more of us walking around with intractable belching.  Incidentally, the GI doc who did the endoscopy was absolutely the most unprofessional, uncaring, hard-of-hearing physician I have ever encountered --- more about him below because I'm wondering whether he, in fact, missed something when he stuck his tv camera down my throat.

4.  Cardiologist.  I am a 59 year old male who had a heart attack five years ago.  I have read somewhere in these medical websites that if one is having chest discomfort, you'd better make sure it's not your heart that's causing the discomfort.  I've noticed that quite a few people on this board experience heart arthmyias related to GI problems, although there seems to be nothing amiss with my heart at this time.

5.  Endocrinologist.  One or more of these medical websites also have suggested there could possibly be a link between intractable belching and thyroid malfunction.  I have been on medication for hypothyroidism for ten years, but a complete thyroid/blood test revealed that my thyroid is functioning within normal ranges.

6.  Gallbladder Ultrasound.  Revealed a completely normal gallbladder, which in the absence of any typical malfunctioning gallbladder pain was unlikely to be the culprit, but we checked it anyway.

7.  Gastrointestinal Specialist at a "leading national research hospital" -- name not to be revealed by me at this point, pending further reports from them.  Esophogael Motility Test and 24-hour ph test, as indicated above, were conducted -- revealing upper and lower esophogael sphincters working normally, but the "tone" of the esophogus was below-normal (that is, as I understand it, the esophogus itself exerts less pressure in moving food toward the stomach --- although I have never had, like many others here have, any trouble swallowing solids or liquids.)

As far as medications are concerned. . . .no over-the-counter drugs have helped one iota.  I've tried them all -- simethicone
based and calcium based. . .even some licorice-based health food store supplement.

I have been on Prilosec and Propulsid for a number of months.  At first, neither seemed to help at all.  I now believe they do probably help a little --- but it was 3-4 months before they seemed to do any good.  My suspicion is that whatever acid reflux I do have --- although it is strange that I don't "taste" any reflux, despite it apparently being there as evidenced by esophogitis and ph-test results --- is caused by the belching;  that is, when one belches as much as I have been, it is bound to suck some stomach acid up into the esophogus;  at least one of the specialists I have seen agrees that there is probably something to this analysis.

I am presently in the midst (one week along) of an experimental self-treatment.  Thirty years ago I was hospitalized with a duodonal ulcer, and the treatment then included the blandest of diets:   soft-boiled eggs, cream of wheat, half-and-half (and Maalox) for two solid weeks.  I know that ulcers are now blamed on the Heliobacter Pylori bacteria, but I decided to try the diet, minus the Maalox, from 30 years ago.  After 3 days on the diet, my intractable belching disappeared by a factor of 98 percent !!!!   It's just been 4 days of this relief, and the bad belching may return in a day or two.  If the relief continues, however, I will need to figure out "what next".  Obviously, one can't spend the rest of his life eating soft-boiled eggs and cream of wheat.  Also, I will have to have answered the question, why is this "diet" working?  Do I have an ulcer that the endoscopy missed?  Is H Pylori still present in me?  Or some other bacteria or fungal organism?  Incidentally, as far as this "diet" is concerned, it is not as low-fat as I normally eat, so fat does not seem to be the "answer."

One last comment and then I'll call it quits on this very long note.  I've read many physician comments that blame this belching on "swallowing air."  I, like many others who have written on this board, find it hard to believe that this is the best diagnosis they can come up with.  I asked the jerk who did the endoscopy on me when he told me my problem was that I was swallowing air, "Why after 59 years do you think I started swallowing air?"  His answer:  "It just happens."  Dahhh.  A number of different sources suggest avoiding sucking on straws, sucking on lolly pops, eating fast, talking and eating at the same time, etc.  Other sources suggest that changes in diet lead to excessive belching.  My own diagnosis leads me to conclude that since I don't suck on lollipops or straws, and I don't chew gum or eat fast or talk & eat, and when this problem first presented itself I had not changed my diet in any significant way, that the answer to my problem lies elsewhere.  I just wish that some of the so-called professionals I have seen would be a little more caring, listen more carefully, and be a lot more competent.

I hope some of this will be of help to other sufferers out there.

If my "new diet" continues to provide relief, I will report that back here, and hope that it might give others some idea of how they might be able to cure their belching problems.  God bless.

Avatar universal
Hi, your posting was most thorough and helpful and reminded me of my own efforts to get help. Holding a pencil  between my teeth was suggested at one point, with no thoughts of how you exist in the world and do that!
In the last year I have found something that improves but doesn't fix my problem, but I am so grateful for some relief that I mention it here.
I was aware that some foods and drinks worsened my problem. I also get arrhythmias and what were called panic attacks, but were always food related. I have now been using a combination of low dose aspirin and a multivitamin with minerals including molybdenum. I did this on the basis that there might be a connection with sulfites, which convert to sulphur dioxide in the  gut, and my symptoms. My symptoms are reduced enormously. From having attacks of 150 beats a minute lasting for some time, I now  get attacks less often, and just over 100 beats. I would love to get rid of it altogether, and stop the short runs of arrhythmia which are so uncomfortable, but believe me, as you know, any relief is wonderful.Good luck in your search. I had the esophageal testing...it is such an ugly experience, isn't it?

Avatar universal
I also have some questions. I think I'm having esophogeal spasms.  I'm a healthy 32 y.o. woman and am awoken from sleep with intense spasmodic pain in my chest that radiates to my back.  It feels exactly like I've swollowed something large and it's stuck in my esophagus, even though I haven't eaten for 10 hours or more.  My pain isn't constant though, I have a spasm every 5 seconds for awhile, then every 10 seconds, then every 15 seconds, and it goes like that for about an hour until it's gone.  The spasms are so painful, they take my breath away.  Does this pain pattern fit the diagnosis?  It always happens between 3 and 5 am and always wakes me up from sleep.  Never happens when I'm awake.
Avatar universal
In one word, YES. The esophagus is a simply a muscle. The esophagus though a simple muscle, is involved with very complex actions brought about thru the central nervous system.
The influence of other muscles within the neck, throat, chest,
abdomen, upper back, etc. is profound and clearly requires  precise coordination to maintain health.

The term " Globus Sensation" or " Globus Histericus", (G.H.)  describes the sensation of something in the throat or upper chest. "Feels like a tennis ball in my throat", " feels like my wind pipe's closing". Globus Histericus? Sometimes, not everytime.

The quickest and least invasive diagnostic procedure might be a 6 to 10 week trial with an antidepresant. Alprazolam may offer some short term reduction in symptoms but a true " Globus H." will require a drug such as Zolof or Prozac. Rapid reduction in symptoms after 2 or more weeks may be diagnostic. The treatment of G.H. may require 6 months to 1 year of continued antidepresant therapy.

There are many benign and destructive reasons for the above described symptoms. One of those could be G.H., and is quite treatable. The history is most often very telling.
Avatar universal
my GOD kathy you just described my proble for 10 years,, though i lived through all the spasms i nknew going to the doctor would be more medicine.. the pain in the back is none stop.. muscel relaxers are my best answer ... but to know others have this let's me at peace of not being crazy.. using my back and stomach sets this off everytime... so i do not sweep or mop or vacume sounds like being lazy but it helps the pain.. thanks for all the input
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