Oesophageal spasm: Lately I've had a strange sensation in my chest under the breast bone. I was worried it was something to do with my heart but my doctor says it's a spasm that happens when I swallow. Can you tell me something more about this condition?
What you describe sounds like oesophageal spasm in which the propulsion of food does not travel down the gullet in the usual way. This causes muscle spasm throughout the oesophagus with the patient experiencing chest pain under the breast bone as you describe.
It often coincides with difficulty swallowing liquids. The spasm commonly occurs at night and may sometimes be severe enough to waken the sufferer. Oesophageal spasm may also produce severe chest pain without swallowing difficulties, often described as a "squeezing" pain under the breast bone.
Do I need to have specific tests to diagnose this condition or can my doctor tell by just examining me?
It can be difficult for the doctor to distinguish oesophageal spasm from chest pain due to angina (caused by a narrowing of the coronary arteries). The usual test is a specialised form of X-ray in which you are asked to swallow a barium drink.
These X-rays may show the barium moving abnormally down the gullet suggesting that food is not being propelled properly. Alternatively, a piece of food can be labelled with a radioactive tracer which will give a moving image of its progress through the oesophagus.
An additional test involves measuring the pressure of the contractions within the oesophagus which provides the most sensitive and detailed analysis of the spasms.
Can it be treated or do I just have to put up with it?
Oesophageal spasm is often difficult to treat. Drugs such as nitro-glycerine, dicyclomine or a calcium channel blocker may relieve the symptoms by relaxing the muscles of the gullet. Your doctor may also prescribe strong pain killers.
Some patients notice that very hot or very cold liquids precipitate the pain so drinks at extremes of temperature are best avoided.
In cases where a narrowing of the gullet has been identified, the oesophagus can be dilated using either a balloon or by inserting progressively larger dilators into the gullet.
Marion Kerr