Key Features of Oesophageal Spasms

Symptoms:

1. Intermittent chest pain, often described as squeezing or pressure
2. Dysphagia (difficulty swallowing)
3. Regurgitation of food
4. Pain triggered by eating, drinking cold beverages, or stress

Physical Examination:

Typically normal, as oesophageal spasms are not associated with physical findings.

Diagnostic Tests:

i. Esophagogastroduodenoscopy (EGD): Often normal in oesophageal spasms, used to rule out other causes.
ii. Oesophageal Manometry: The gold standard for diagnosing oesophageal spasms, shows abnormal oesophageal contractions.
iii. Barium Swallow: May show corkscrew oesophagus in diffuse oesophageal spasm.

Management:
. Calcium Channel Blockers (e.g., diltiazem or nifedipine): First-line treatment to relax oesophageal smooth muscle.
. Nitrates (e.g., nitro-glycerine): Can be used for acute relief but not typically first-line due to side effects.
. Tricyclic Antidepressants (e.g., amitriptyline): For patients with refractory symptoms.
. Lifestyle Modifications: Avoiding trigger foods and stress management.