Treatment

Treatment depends on the frequency and severity of your esophageal spasms.

If your spasms are occasional, your doctor might first recommend avoiding extremely hot or cold foods to see if that relieves your symptoms.

If your spasms make it difficult to eat or drink, your doctor might recommend:

• Managing any underlying conditions. Esophageal spasms are sometimes associated with conditions such as heartburn or gastroesophageal reflux disease (GERD). Your doctor might recommend a proton pump inhibitor to treat GERD, or an antidepressant, such as imipramine (Tofranil), which may help reduce the sensation of pain in the esophagus.
• Medications to relax your swallowing muscles. Peppermint oil, onabotulinumtoxin A (Botox) injections or calcium channel blockers, such as diltiazem (Cardizem, Tiazac, others), can reduce the severity of spasms.
• Surgery (myotomy). If medication doesn't work, your doctor might recommend a procedure that involves cutting the muscle at the lower end of the esophagus to weaken esophageal contractions. Long-term studies of this approach aren't available, so myotomy generally isn't recommended for esophageal spasms. However, it might be considered if other treatments don't work.
• Peroral endoscopic myotomy (POEM). In this new minimally invasive technique, an endoscope inserted through your mouth and down your throat allows a surgeon to make an incision in the inside lining of your esophagus. Then, as in standard myotomy, the surgeon cuts the muscle at the lower end of the esophagus. Like standard myotomy, POEM is usually considered only if other treatments don't work.