What is distal esophageal spasm?
Distal esophageal spasm (DES), formerly known as diffuse esophageal spasm, is a condition that affects how the muscles of the esophagus work. The esophagus normally moves food and liquids to the stomach through coordinated, wave-like muscle contractions. With distal esophageal spasm, these contractions occur too early, too forcefully, or in an uncoordinated pattern, making it difficult for food to move normally into the stomach.

Distal esophageal spasm is not life-threatening, but it can cause bothersome swallowing symptoms and chest pain.

What causes distal esophageal spasm?
The exact cause of distal esophageal spasm is not fully understood. It is thought to occur when the nerves that control the muscles of the esophagus do not function normally, causing abnormal muscle contractions.

In some people, the lower esophageal sphincter (LES)—the muscle that separates the esophagus from the stomach—may also contribute to symptoms by not relaxing properly.

Some individuals also have increased sensitivity of the nerves in the esophagus, causing normal muscle contractions to feel painful.

Symptoms of distal esophageal spasm
Symptoms can vary from person to person and may come and go.

Common symptoms include:

  • Difficulty swallowing food or liquids
  • Food feeling stuck in the throat or chest
  • Chest pain that is not related to the heart
  • Pain or discomfort when swallowing
  • Episodes of symptoms that occur intermittently

Because chest pain can have many causes, it is important to seek medical evaluation to rule out heart-related conditions when appropriate.

Diagnosing distal esophageal spasm
Your provider will review your symptoms and medical history, and perform a physical exam. Testing is often recommended to rule out other causes of swallowing difficulties, such as gastroesophageal reflux disease (GERD), narrowing of the esophagus, or other esophageal disorders.

Testing may include:

High-resolution esophageal manometry is the primary test used to diagnose distal esophageal spasm because it measures the timing and strength of muscle contractions in the esophagus during swallowing.

Treatment for distal esophageal spasm
Treatment focuses on reducing symptoms and improving swallowing. Your provider will recommend a treatment plan based on the severity of your symptoms.

Treatment options may include:

  • Eating slowly and chewing food thoroughly
  • Avoiding foods or beverages that trigger symptoms, including very hot or very cold foods
  • Medications to relax the muscles of the esophagus
  • Medications that reduce nerve-related pain
  • Acid-reducing medications when gastroesophageal reflux disease (GERD) is also present
  • Botulinum toxin (Botox) injections
  • Peroral endoscopic myotomy (POEM)
  • Surgery in selected cases when other treatments have not been successful

Ongoing monitoring and follow-up care
Regular follow-up appointments allow your provider to monitor your symptoms and determine whether your treatment plan should be adjusted over time.

If symptoms continue despite treatment, additional testing or alternative therapies may be recommended.

When to seek care
Contact your healthcare provider if you experience:

  • Difficulty swallowing that persists or worsens
  • Food frequently feeling stuck in your chest
  • Chest pain that continues despite treatment
  • New or worsening symptoms

Seek emergency medical care immediately if you experience severe chest pain that could be related to your heart or if food becomes lodged in your esophagus and you are unable to swallow saliva, liquids, or breathe normally.

Contact us
If you have questions about distal esophageal spasm or treatment options, please contact our office at 612-871-1145.