Dear Dr James,
“I have two seemingly related problems – unheralded episodes of sudden severe pain behind the breast bone spreading up into the jaw that can be alleviated by sipping warm water. If this comes on when eating, the mouthful of food gets stuck as if there is a blockage – eventually resolving with a lot of burping.”
Dear reader,
There are several possible reasons for pain and difficulty with swallowing – a hiatus hernia, stricture or tumour. But when, as here, the symptoms are intermittent and transient it is possible to infer they are due to spasms of the circular muscles surrounding the oesophagus whose rhythmical contractions propel food down into the stomach.
These spontaneous spasms may be diffuse and uncoordinated so the tube-like oesophagus, when visualised, has the appearance of a corkscrew – or “hyper-contractible” where the amplitude and duration of the normal contractions are much elevated. Their cause is unknown though they may be triggered by hot or icy cold drinks or brought on by acid reflux – the upward reflux of the stomach’s acidic secretions into the lower oesophagus.
Simple remedies
The spasms may be neutralised with small sips of warm water, as mentioned above. The late David Taylor, a former professor of medicinal chemistry, favours the muscle relaxant properties of alcohol. “Oesophageal spasm can last for some time and be very distressing,” he wrote from personal experience. “I find it can usually be fixed with a slug of schnapps. Vodka is good but I imagine any sort would do.” Alternatively, a reader who has “suffered for years” commends sucking on an extra-strong peppermint. “This usually works straight away. Only infrequently have I had to take a second.”
Acid suppressants
Acid reflux, even in the absence of its classic symptom of heartburn may, by irritating the lining of the oesophagus, be a contributory factor. Hence an acid suppressant such as Lansoprazole can be a highly effective preventive measure. “I have been taking them for several years now,” writes a reader particularly troubled by episodes at mealtimes. “They have completely resolved my swallowing problem without adverse effects.”
Calcium blockers and GTN spray
These work in lowering blood pressure and relieving angina pains respectively by relaxing the muscles in the lining of the blood vessels causing them to dilate. The same mode of action accounts for their merits in preventing spasms of the oesophageal muscles.
Surgery
Though certainly distressing and inconvenient oesophageal spasms have no long-term adverse consequences. But for the few in whom they persist despite these relatively simple measure more radical procedures may be called for – such as inserting a balloon into the lower oesophagus whose inflation forcibly stretches the surrounding muscles.
In a study of 20 patients from Guy’s Hospital, this resulted in a “good clinical improvement” in 14. As a last resort, an operation known as a myotomy involves cutting through the affected muscles. This can now be performed through an endoscope and is reported to have a 90 per cent long-lasting response rate though, it is noted that it “should only be considered after the risk-benefit ratio has been carefully evaluated”.
Email queries and comments in confidence to drjames@telegraph.co.uk
Disclaimer: The copyright of this article belongs to the original author. Reposting this article is solely for the purpose of information dissemination and does not constitute any investment advice. If there is any infringement, please contact us immediately. We will make corrections or deletions as necessary. Thank you.
