Review article: oesophageal spasm - diagnosis and management

Aliment Pharmacol Ther. 2006 May 15;23(10):1393-402. doi: 10.1111/j.1365-2036.2006.02917.x.


Oesophageal spasm is a common empiric diagnosis clinically applied to patients with unexplained chest pain. In contrast it is an uncommon manometric abnormality found in patients presenting with chest pain and/or dysphagia and diagnosed by >or=20% simultaneous oesophageal contractions during standardized motility testing. Using Medline we searched for diagnostic criteria and treatment options for oesophageal spasm. While the aetiology of this condition is unclear, studies suggest the culprit being a defect in the nitric oxide pathway. Well-known radiographic patterns have low sensitivities and specificities to identify intermittent simultaneous contractions. Recognizing that simultaneous contractions may result from gastro-oesophageal reflux this diagnosis should be investigated or treated first. Studies have documented improvements with proton-pump inhibitors, nitrates, calcium-channel blockers and tricyclic antidepressants or serotonin reuptake inhibitors. Small case series reported benefits after botulinium toxin injections, dilatations and myotomies. Uncertainties persist regarding the optimal management of oesophageal spasm and recommendations are based on controlled studies with small numbers of patients or on case series. Acid suppression, muscle relaxants and visceral analgetics should be tried first. Botulinium toxin injections should be reserved for patients who do not respond. Pneumatic dilatations or myotomies represent rather heroic approaches for non-responding patients.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Antidepressive Agents / therapeutic use
  • Botulinum Toxins / administration & dosage
  • Calcium Channel Blockers / therapeutic use
  • Chest Pain / etiology
  • Chest Pain / physiopathology
  • Dilatation / methods
  • Esophageal Spasm, Diffuse / diagnosis
  • Esophageal Spasm, Diffuse / physiopathology
  • Esophageal Spasm, Diffuse / therapy*
  • Esophagus / surgery
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / physiopathology
  • Humans
  • Injections
  • Manometry / methods
  • Mentha piperita
  • Nitroglycerin / therapeutic use
  • Parasympatholytics / administration & dosage
  • Phosphodiesterase Inhibitors / therapeutic use
  • Plant Oils / administration & dosage
  • Proton Pump Inhibitors
  • Vasodilator Agents / therapeutic use


  • Antidepressive Agents
  • Calcium Channel Blockers
  • Parasympatholytics
  • Phosphodiesterase Inhibitors
  • Plant Oils
  • Proton Pump Inhibitors
  • Vasodilator Agents
  • peppermint oil
  • Botulinum Toxins
  • Nitroglycerin