Hello, Thanks for your query. Medical and surgical options are available for the treatment of diffuse esophageal spasm and nutcracker esophagus and have been used with moderate success. Medical treatment consists of calcium channel blockers, nitrates, tricyclic antidepressants, sildenafil, botulinum toxin, and dilatation. Treatment is focused on symptom reduction and begins with reassurance, especially in light of the psychiatric component in many patients. Since the most frequent complaint is pain, which may be related to gastroesophageal reflux and not the motor disorder, treatment directed at resolving the gastroesophageal reflux with proton pump inhibitors improves the spasm and the patient s symptoms. Calcium channel blockers (eg, diltiazem) can reduce the amplitude of the contractions. Nitrates also have been used with some success. Tricyclic antidepressants, specifically imipramine, have been shown to decrease chest pain. For extreme cases, operative treatment usually involves a myotomy. Myotomy relieves symptoms by eliminating the effectiveness of the contractions. Traditionally, a thoracotomy was required to obtain access to the esophagus, but now, a thoracoscopic approach can be used. If you want to know more you can write back to me. Thank you.