DEAR DR. GOTT: About once a month, I get esophageal spasms, diagnosed as such by my doctor. The pain actually mimics that of a heart attack, with pain across my chest and back. It lasts about 20 minutes.

Can you tell me what causes the spasms, how they could be prevented and what to do when they occur? I know there is a pill I could take, but I am not anxious to add another pill to my regimen. I would appreciate any information you can provide on this ongoing problem.

DEAR READER: Spasms of the esophagus are muscle contractions that prevent food from passing in a normal manner from the esophagus into the stomach.

Symptoms resemble those of gastroesophageal reflux disease (GERD) and can include heartburn, chest pain and more. Contractions can be quite painful, intermittent and vary in intensity, with chest pain mimicking angina. Women are more commonly affected by the condition than are men, and the probability of developing the condition increases as a person ages.

There are a number of steps a person can take to control symptoms. Diet modification can help. Eliminate or reduce your intake of acidic, greasy/fatty and spicy foods. Try eating four or five smaller meals rather than two or three large ones. You should also avoid foods that are extremely hot or cold, as they can trigger an attack.

Short-term treatment may involve an over-the-counter or prescription medication to relax the muscles of the esophagus. Long-term treatment can include the use of additional medications and determining possible underlying health conditions.

Testing by a physician for diagnosis might include the coordination of a barium swallow, esophageal motility test, esophageal computed tomography (CT) scanning or esophagogastroduodenoscopy. Your physician or gastroenterologist is your best resource to determine which procedure is appropriate to determine if any blockages are present and reach a diagnosis.

To give you related information, I am sending you a copy of my Health Report "Hiatal Hernia, Acid Reflux & Indigestion." Other readers who would like a copy should send a self-addressed, stamped, No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR DR. GOTT: My son suffers from nosebleeds. I'd like to know if there is something he can do for the problem.

DEAR READER: Nosebleeds can be caused by infection, sinusitis, rhinitis, dry winter weather and foreign bodies that have been inserted into the nose. The latter is quite common with young children. People on certain medications, such as Coumadin, aspirin and anti-inflammatory drugs, are susceptible. Alcohol abuse, hypertension and several other medical conditions can contribute to repeated bouts.

Your son should be seen by his physician to detect a possible underlying cause. If his physician doesn't feel comfortable with this, he should be seen by an otolaryngologist, a specialist in the field of ear, nose and throat disorders.

Home treatment for simple cases involves pinching the lower portion of the nostrils together with the head held back for up to 10 minutes. If that fails, it may be necessary to pack the nose with an absorbent material, such as a rolled gauze pad, for up to 10 minutes. If this also fails and the bleeding is profuse, he should seek professional help through a local emergency room or clinic.