A case of oesophageal spasm, and the ‘unproven’ treatment that helped it

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A couple of weeks back I was talking with a close family member, and he mentioned that for many years he had been getting digestive discomfort that tended to come after meals. When I asked to point to where his pain was, he indicated that it was in the middle of the abdomen just at the end of the breastbone. In medicine, this region is referred to as the ‘epigastrium’, and pain here is generally a sign of an issue in the stomach or lower end of the oesophagus (food pipe). Often, the issue is related to ‘reflux’, where acidic stomach contents come up into the oesophagus and cause pain here. Simple antacids or acid-suppressing medication will usually stop symptoms if that’s the case, but this approach hadn’t worked here.

In fact, closer questioning revealed no prior symptoms of ‘acidity’, reflux or regurgitation. The suggestion here being that excess ‘acidity’ in the stomach was unlikely to be the problem.

In natural medicine, some practitioners (including I) believe that symptoms of excess acidity can actually be the result of a low levels of stomach acidity (the medical term for which is ‘hypochlorhydria’). See here and here for more about this.

However, my family member did not have any symptoms that were particularly suggestive of this either (such as getting full quickly on eating, epigastric bloating immediately after meals or the feeling of food getting ‘stuck’ in the stomach for some hours after eating). All-in-all, this was not looking like his symptoms were due to over- or under-secretion of acid.

One other potential cause of discomfort in the epigastrium that comes from the digestive tract is ‘oesophageal spasm’. Here, any part of the oesophagus, including the sphincter at its lower end, can ‘cramp up’, causing quite intense pain and discomfort. It is, in my experience, quite a common problem, but one which tends not to be thought about much in conventional medicine.

I remember once attending a nutritional therapy course for doctors in the US, in which one of the facilitators (Dr Jonathan Wright) said, If it spasms, think magnesium (or something similar). And this sagely piece of advice was based on the idea that low levels of magnesium in the body tend to cause muscle to go into spasm. This might include so-called ‘smooth’ muscle in, say, the digestive tract, bladder on in the walls of the arteries. It might also include ‘skeletal’ muscle, say, in the legs. Ever since hearing learning this I’ve used magnesium generally very effectively to treat conditions like muscular cramps, ‘restless legs’, irritable bladder syndrome and oesophageal spasm.

So, with this I mind I suggested that my family member supplement with magnesium to see if this helps his symptoms. In short, it did. Within a day or two of taking magnesium, the epigastric discomfort that had plagued him on a daily basis for years disappeared, and has seemingly not returned some 10 days later.

Of course, we cannot be sure that it was the magnesium that did the trick. Maybe it was a spontaneous resolution (unlikely after years of consistent symptoms). Or perhaps it was just a placebo response? We’ll never know. But, then again, my family member is not inclined to know. All he really cares about is that a persistent, recurrent digestive discomfort he has had for years is now gone.

The main reason for writing about this issue is because I think it would be good if oesophageal spasm got more widespread recognition.

However, it also reminded me of how often in practice I and other health professionals can be faced with a health issue for which there is no ‘proven’ treatment. I don’t believe magnesium has been studied with regard to its impact of oesophageal spasm. However, in this case giving it appears to have worked to resolve longstanding symptoms. Even if this is down to nothing more than a placebo response, then few would deny that my family member is better off for taking the magnesium.

However, imagine for a moment that magnesium therapy had been studied for oesophageal spasm and not been found to be effective (compared to placebo). Does that mean that we should not use magnesium to treat oesophageal spasm? Some would argue we shouldn’t. However, even when a treatment has been shown to be ineffective compared to placebo in a study, that does not mean it cannot work in a single individual (including the person sitting opposite you in practice). The other thing worth bearing in mind that even when a treatment has been proven, if it appears to work in an individual in practice, we can never be sure if this is was because of some genuine action or a placebo response (or something else).

This recent experience with my family member reminded me of just how limited scientific evidence can be in real life. And how important it can be to be open to ‘unproven’ treatments if, as healthcare practitioners, we’re committed to doing our best for our patients and those we advise.

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