Esophageal Spasms and Chest Pain

[kasbb86]

I have been experiencing chest pains just to the left of the sternum.  The pains can be either long in duration and a dull throbbing sensation - or sharp and short in duration.  Have consulted with a Cardiologist, who did a full work up, including EKG, stress test and Angiogram - all normal.  Next consulted with a Pulmonologist - all normal.

Finally consulted with two Gastroenterologists, who did the following tests:

Barium swallow test (double contrast esophagram), showed  no ulcerations, strictures, masses, diverticula or hiatal hernia.  Test did show some mild dismotility in the upright position, with intermittent esophageal spasms.

Upper Endoscopy with biopsy.  Biopsy normal.  Normal gastroesophageal junction.  Abnormal motility noted in the middle third and lower third of the esophagus.  (Upper third normal.)  Doctor put me on Prevacid and Baclofen for 2 months - but no cessation of chest pain.  Put me on Cardizem for 1 month - no cessation of chest pain.

Esophageal Motility test showed some spasms in the esophagus.

I have a very moderate and mild diet, yet have this chest pain several times per week, with episodes lasting for hours some times.  I need to know if there is any way to positively determine that this chest pain is resulting from esophageal spasms - or should I be looking elsewhere?

Is there any long-lasting treatment for esophageal spasms?

[Kevin Pho, MD]

You have had a pretty thorough evaluation for your symptoms, and given the evaluation by two GI physicians, it is unlikely that I can come up with something new over the internet.

Typically, the treatment for esophageal spasm is with a calcium channel blocker. If the symptoms continue, a nitrate can be added on an as needed basis when the symptoms flare up.

Another consideration would be the administration of botulinum toxin, but this is more investigational and reserved for more refractory cases.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[KAYMI]

I have a hiatal hernia and was told 1/4th of my stomach has slipped through a hole & is in my chest cavity & by or pushing by my heart. The surgeon I counseled with said he wouldn't do surgery on me right now because I also have other health issues & I wouldn't make it through the surgery should I seek the opinion of another surgeon? This is life threatening, right?