Cricopharyngeal spasm

Cricopharyngeal spasms occur in the cricopharyngeus muscle of the pharynx. These spasms are frequently misunderstood by the patient to be cancer due to the 'lump in the throat' feeling (Globus pharyngis) that is symptomatic of this syndrome. In practice, real lumps in the throat, such as a cancer, are generally not felt until they impede ingestion of food. This is one of the reasons that a cancer can get so big before it is discovered. However, a cricopharyngeal spasm is a harmless, if uncomfortable, self-limiting disorder and will resolve itself over a period of time.

Physiology

There are two sphincters in the oesophagus. They are normally contracted and they relax when one swallows so that food can pass through them going to the stomach. They then squeeze closed again to prevent regurgitation of the stomach contents. If this normal contraction becomes a spasm, these symptoms begin.

Symptoms

• Sensation of a 'lump' in the back of the throat
• Throat feels swollen
• Discomfort - Lump can often feel quite big and pain is occasional
• Symptoms normally worse in the evening
• Stress aggravates the symptoms
• Saliva is difficult to swallow, yet food is easy to swallow - eating, in fact, often makes the tightness go away for a time
• 'Lump' sensation comes and goes from day to day
• Symptoms can persist for very long periods, often several months.
• The symptoms can be mimicked by pushing on the cartilage in the neck, just below the Adam's apple

Causes

Causes include stress and anxiety. Other causes are not yet clear. In some cases, eating certain foods may bring on acute spasms, in susceptible individuals. Peanuts, pumpkin seeds and other nuts may trigger these spasms.

Treatment

No cure for the condition as such exists. A number of treatments may provide partial relief:

• Botox injections may temporarily disable the muscle and provide relief for 3-4 months per injection^[1]
• Muscle relaxants
  • Lorazepam (Ativan), diazepam (Valium) and other benzodiazepines relax the smooth muscle in the throat, slowing or halting contractions. In some people, benzodiazepines may have addictive properties.
• Stress reduction
  • High stress levels make these spasms more noticeable
  • It is advisable to take note of when your symptoms are at their worst
• Warm fluids
  • Hot fluids may be helpful for some people with cricopharyngeal spasm (or other esophageal disorders)^[2]

References

1. ↑ Parameswaran MS, Soliman AM (2002). "Endoscopic botulinum toxin injection for cricopharyngeal dysphagia". The Annals of Otology, Rhinology, and Laryngology. 111 (10): 871–4. PMID 12389853. 
2. ↑ Triadafilopoulos, G; Tsang, HP; Segall, GM (June 1998). "Hot water swallows improve symptoms and accelerate esophageal clearance in esophageal motility disorders.". Journal of Clinical Gastroenterology. 26 (4): 239–44. doi:10.1097/00004836-199806000-00003. PMID 9649001. 

External links

• Bastian Medical Media