Esophageal spasms are abnormal contractions of the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach. These spasms can cause sudden chest pain, swallowing difficulties, and digestive discomfort. Although not life-threatening, they can severely impact daily life and are sometimes mistaken for heart-related problems.

Also known as nutcracker esophagus, diffuse esophageal spasm (DES), or distal esophageal spasm, this condition is rare, affecting approximately 1 in 100,000 people. Understanding the symptoms, triggers, causes, and treatment options is essential for better management.

Symptoms of Esophageal Spasm

Esophageal spasms can mimic the feeling of a heart attack, which makes them particularly concerning. The most common symptoms include:

  • Chest pain: Crushing, squeezing, or sharp pain located behind the breastbone (retrosternal pain). The discomfort can radiate to the back, arms, or jaw.

  • Difficulty swallowing (dysphagia): A sensation of food being “stuck” in the throat or chest, even when the esophagus is clear.

  • Globus sensation: The false feeling of a lump in the throat.

  • Regurgitation: Backflow of undigested food or stomach acid into the esophagus, sometimes leading to heartburn or vomiting.

  • Voice hoarseness and chronic cough: Especially in people with repeated regurgitation.

Symptoms may last anywhere from a few minutes to over an hour. They often occur after eating or drinking very hot or cold foods but can also appear without warning. In severe cases, frequent spasms may lead to unintended weight loss due to fear or difficulty with eating.

Causes of Esophageal Spasms

Researchers do not yet fully understand why esophageal spasms happen. However, several underlying factors and theories have been identified.

Altered Nerve Activity

Normally, the esophagus contracts in a coordinated wave-like motion to push food into the stomach. This process is controlled by nerve signals and takes just a few seconds. In esophageal spasms, the nerves misfire, creating uncoordinated or simultaneous contractions.

Nitric oxide, a chemical messenger that relaxes muscles, is believed to play a role. Low levels of nitric oxide may increase contraction frequency, triggering spasms.

Gastroesophageal Reflux Disease (GERD)

Chronic acid reflux can damage the esophageal lining and disrupt nerve signaling. GERD symptoms—such as heartburn, nausea, hoarseness, and swallowing problems—are frequently reported in patients with esophageal spasms. Prolonged exposure to stomach acid may alter esophageal muscle function and trigger spasms.

Spastic Achalasia

This rare motility disorder occurs when the lower esophageal sphincter (LES) fails to relax, preventing food and liquids from reaching the stomach. Symptoms include:

  • Severe swallowing difficulties

  • Night-time coughing or wheezing

  • Chest pain and regurgitation

  • Weight loss due to poor food intake

Some cases of esophageal spasm may progress into spastic achalasia.

Triggers of Esophageal Spasms

While causes are not always clear, specific triggers have been identified:

  • Hot or cold foods and drinks (ice cream, popsicles, hot tea, coffee, or soup)

  • Spicy meals

  • High-fat foods (fried foods, red meats)

  • Caffeinated beverages (coffee, black tea, energy drinks)

  • Emotional stress and anxiety

Keeping a symptom diary can help identify personal triggers.

Risk Factors

Anyone can develop esophageal spasms, but certain groups are more prone:

  • Older adults (average onset around 60 years old)

  • Women (higher prevalence among people assigned female at birth)

  • Individuals with GERD or acid reflux disease

  • People with a history of esophageal motility disorders

When To See a Healthcare Provider

Because chest pain can signal a heart attack, immediate medical attention is necessary if pain lasts longer than five minutes.

Seek medical advice if you experience:

  • Repeated swallowing difficulties

  • Persistent regurgitation

  • Chest pain after eating or drinking

  • Unexplained weight loss

How Esophageal Spasms Are Diagnosed

To rule out heart-related conditions, healthcare providers may first conduct tests such as EKG or angiograms. If cardiac issues are excluded, diagnostic tools for esophageal spasm include:

  • Endoscopy: A flexible camera inspects the esophagus for damage or blockages.

  • Barium swallow: After swallowing a liquid containing barium, X-rays reveal narrowing or irregularities.

  • Esophageal manometry: A catheter with sensors measures esophageal muscle contractions during swallowing.

Treatments for Esophageal Spasm

Treatment depends on severity and frequency of spasms. Options include:

Home Remedies

  • Peppermint oil: Shown in studies to reduce esophageal muscle contractions.

  • Warm water or soothing teas may also help relax the esophagus.

Medications

  • Proton Pump Inhibitors (PPIs) (omeprazole, lansoprazole) to manage GERD-related symptoms.

  • Nitrates (nitroglycerin, isosorbide dinitrate) to relax muscles and prevent spasms.

  • Calcium-channel blockers (diltiazem, nifedipine) to ease contractions.

  • Tricyclic antidepressants (imipramine) to reduce pain perception.

  • Botox injections: Temporarily block nerve activity in the esophagus, lasting 6–12 months.

Surgery

For severe, treatment-resistant cases, doctors may recommend Peroral Endoscopic Myotomy (POEM). This minimally invasive procedure cuts abnormal muscle fibers to restore normal swallowing.

Prevention and Lifestyle Tips

Although spasms cannot always be prevented, lifestyle adjustments can reduce frequency:

  • Avoid extreme hot or cold foods.

  • Limit caffeine, alcohol, fatty, and spicy meals.

  • Eat smaller, more frequent meals.

  • Manage stress with relaxation techniques, yoga, or breathing exercises.

  • Keep a food and symptom journal to identify personal triggers.

A Quick Review

Esophageal spasms are painful contractions of the esophagus that cause chest pain, swallowing problems, and regurgitation. While rare, they are often mistaken for heart conditions.

  • Causes: Abnormal nerve signaling, GERD, spastic achalasia.

  • Triggers: Hot/cold foods, fatty meals, caffeine, stress.

  • Diagnosis: Endoscopy, barium swallow, manometry.

  • Treatment: Peppermint oil, medications, Botox injections, or surgery in severe cases.

With proper diagnosis and treatment, most people can manage symptoms and improve quality of life.