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Emergency Medicine31 papers

Spasm of the cricopharyngeus muscle

Last edited: 4/16/2026

Overview

Spasm of the cricopharyngeus muscle, also known as cricopharyngeus achalasia or nutcracker esophagus, involves involuntary contractions of the lower esophageal sphincter, leading to dysphagia and regurgitation 1.

Diagnosis

  • Clinical presentation includes dysphagia, regurgitation, and chest pain 1.
  • No specific diagnostic tests are highlighted; diagnosis often clinical 1.
  • Esophagogastroduodenoscopy (EGD) may rule out other esophageal disorders 1.
  • Manometry can confirm impaired relaxation of the cricopharyngeus muscle 1.

    • Management

  • First-line treatments:
    • - Benzodiazepines (e.g., diazepam) for symptomatic relief 1.
  • Adjunctive treatments:
    • - Dietary modifications, such as smaller, more frequent meals 1. - Avoidance of trigger foods that exacerbate symptoms 1.

    Special Populations

  • Elderly: Use of benzodiazepines should consider potential for dependence and efficacy 1.
  • Comorbidities: No specific guidance provided; individualized treatment approach recommended 1.

    • Key Recommendations

  • Consider benzodiazepines (e.g., diazepam) for symptomatic relief in patients with cricopharyngeus muscle spasm, acknowledging potential for dependence 1 (Evidence: Moderate).
  • Evaluate and manage dysphagia through clinical assessment and consider EGD to exclude other pathologies 1 (Evidence: Moderate).
  • Implement dietary adjustments and monitor response to therapy in elderly patients due to increased risk of medication side effects 1 (Evidence: Expert opinion).

    • References

    1 Nazareth ID, King MB. Prescribing of benzodiazepines by casualty officers. Journal of the Royal Society of Medicine 1989. link

    Original source

    1. [1]
      Prescribing of benzodiazepines by casualty officers. — Nazareth ID, King MB Journal of the Royal Society of Medicine (1989)
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