Doc: Esophagus spasms can be mistaken for heart attack
Dear Dr. Roach: Can you provide any tips for dealing with “jackhammer” esophageal spasms? Eleven months ago, I had my first attack of these dreadfully painful spasms, which lasted for about 30 minutes. The immediate trigger was red wine. In subsequent small experiments, I have discovered that they can be triggered by red and white wines.
I have avoided wine since then, but recently I had another painful attack that lasted for about 60 minutes. I was near the end of a sushi dinner and assume that the trigger probably was the vinegar used in the sushi rice (which I will now avoid). The spasms, which rate a 10 out of 10 on the pain scale, were about 10 seconds apart. Since it is possible that they will occur again, I am wondering if there is any way to stop them once they have started. When I phoned a local health hotline, the nurse suggested deep breathing and peppermint. I used both of these, but I don’t know whether they helped or if the spasms simply subsided with time.
Dear A.M.: Esophageal spasm is a condition where the nerve control of the muscles of the esophagus is chaotic, leading to uncontrolled contractions. Most people complain of pain or discomfort in the chest, often associated with difficulty swallowing. It can be mistaken for a heart attack. The diagnosis is made by measuring the pressures inside the esophagus.
I have not read much about dietary triggers for esophageal spasm, so I am interested to hear that you have been able to identify foods that trigger symptoms in you. Avoiding triggers is a key treatment in many diseases, and often requires keeping a diary in order to identify consistent triggers.
The nurse you spoke to gave you one treatment, peppermint oil, which has been shown to have benefit in at least one small trial. Peppermint candies with a very high concentration of peppermint oil, such as Altoids, may be of benefit.
Pharmacological treatment is usually with calcium channel blockers, such as diltiazem, or with antidepressants (which work on the nerve cells, similar to the way they work in people with neuropathy, but are not used in the doses they would be for depression). Two classes of drugs that you might not expect to work, nitroglycerine and sildenafil (Viagra), also have shown benefit.
Botulinum toxin is sometimes injected into the esophagus for longer-term treatment.
Dear Dr. Roach: I’ve wondered for a long time if hair tints and dyes cause cancer. How about a weekly hair rinse?
Dear D.E.B.: The American Cancer Society has written about this (bit.ly/1CztvhD); in summary, people exposed to hair dyes at work have a small increase in risk for bladder cancer. There has not been a consistent link between using hair dyes and cancer, although hair dyes in use prior to 1980 may have increased the risk for blood cancers. Permanent and semi-permanent dyes are where the risk is thought to be, not temporary dyes that wash out after one or two washings.
It’s recommended to use gloves when working with dyes, and to rinse thoroughly. I want to emphasize that if there is an increased risk in cancer from the chemicals in hair dyes, the risk is small.
Email questions to ToYourGoodHealth@med.cornell.edu.