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Nutcracker Esophagus

Nutcracker Esophagus

Nutcracker esophagus is a condition associated with very high pressures (greater than 180 mm Hg) that happen in the esophagus during the swallowing process. These elevated pressures may cause poor swallowing of both solid and liquid foods.

Causes

One of the major causes of nutcracker esophagus is gastroesophageal reflux disease. It can affect everyone and is more frequently seen in patients in their 60s and 70s.

Symptoms

Chest pain, heartburn and dysphagia (difficulty swallowing) are the most common symptoms of nutcracker esophagus. The chest pain can be intermittent and not related to food intake. Therefore it needs to be differentiated from cardiac chest pain. Although nutcracker esophagus can sometimes produce obstructive symptoms, the esophagus is not physically blocked.

Diagnosis

As with other esophageal motility disorders, high-resolution manometry and a videoesophagram are essential to make the diagnosis and differentiate nutcracker esophagus from other disorders with similar symptoms. An upper endoscopy might also be necessary to rule out other causes of chest pain and dysphagia, such as chronic gastroesophageal reflux disease or achalasia.

Treatment

Nutcracker esophagus is a benign disease and rarely requires treatment. In a few cases, smooth-muscle relaxers such as sublingual nitroglycerin or long acting forms of nitroglycerin can be used. Calcium channel blockers and antidepressants also have been used to treat the symptoms.

By Michel Kafrouni, M.D.

References

1.Tutuian R, Castell D. "Esophageal motility disorders (distal esophageal spasm, nutcracker esophagus, and hypertensive lower esophageal sphincter): modern management". Curr Treat Options Gastroenterol, 2006, 9 (4): 283–94.
2. Konturek T, Lembo A. Spasm, nutcracker, and IEM: real or manometry findings? J Clin Gastroenterol. 2008 May-Jun;42(5):647-51